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January 15, 2022

Omicron in Decline?

Here's Hoping! 

I follow the NY Covid-19 infection rates for the State, NY City, and Manhattan on the NY Forward Dashboard.  I was very happy to see the decline in the numbers this past week and decided to post some information from specific days in the two winter surges.

Last Year  1.4.2021       NYS  8.3%    NYC   6.9%        Manhattan   3.3%  Approx Peak

        1.15.2021    NYS  5.8% NYC  5.1% Manhattan   3.1%

        2.15,2021    NYS  5.0% NYC  5.5% Manhattan   3.9% 

                5.29.2021    NYS  0.6%     NYC   0.4%        Manhattan   0.3%  Approx Nadir

    

               10.15.2021   NYS  2.4% NYC  1.2% Manhattan   0.9%     Nadir Pre-Surge

        11.26.2021   NYS  4.7% NYC  2.2% Manhattan   2.1%     Omicron Announced      

12.27.2021   NYS  19.3%   NYC  19.6%       Manhattan   17.5%

 This Year 1.2.2022       NYS  23.4%  NYC   22.7% Manhattan    18.6%   Peak Numbers 

1.13.2022     NYS  16.3%  NYC   14.3% Manhattan    10.7%  

These numbers for the infection rate were posted by New York testing sites almost since the beginning of the pandemic and I followed them on a daily basis.  In late December 2021 the state was testing from 300,000 - 400,000 people per day - and an unknown number of patients were doing rapid tests at home. The surge in December and January were unprecedented. comparing the case numbers to the winter surge in 2020-21.  Each day I was shocked to see how fast the infection rate was rising.  On 12/25 the omicron variant was 85.4% and on Jan 1st it was 98%.  In the 1.12 graph I discussed it is clear that the rapid rise in cases in NYC was in the unvaccinated people.  The rapid DECREASE IN CASE NUMBERS now can give us hope that this infection rate will continue to plumet as in South Africa.     

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January 12, 2022

Infection Numbers in Fully Vaccinated vs Unvaccinated

Yesterday the New York Times had graphs for Covid-19 infections in New York City and Seattle, both cities had timely data for the rates of infection.  In NYC the graph shows the number of weekly cases per 100,000 from Nov 6th to Dec. 18th.  Infections in NYC by 12/25 were more than 85% omicron variant. The Y axis on the graph  is 0-3000 cases per 100,000 people.  Vaccination doesn't prevent "infection", but does block severe disease.  and this is also seen in hospitalizations and deaths in the graphs published in the NYT article for each..  The graphs for Seattle are also very similar - telling a consistent story.

The other two graphs for NYC also demonstrate a stark difference between the unvaccinated and fully vaccinated less than 1 month ago.

HOSPITALIZATIONS: Not fully vaccinated - 80 weekly per 100,000 people.  Less than 10 weekly per 100,000 people in the fully vaccinated.  Statistics from other studies show that many of these people (as many as 40%) are hospitalized with other diagnoses, but were positive for Covid-19 when tested.

DEATHS:  Not fully vaccinated - 4 weekly per 100,000 people.  Less than 1 in the fully vaccinated and the graphs show the big difference.  Deaths tend to lag 2-3 weeks after being infected, so the differences are expected to continue to rise. 

UnvacciantedOmicronSIZE.jpg

 

January 8, 2022

Isolation vs Quarantine

The CDC has revised guidelines for Isolation and Quarantine in the face of the surge of omicron Covid infections throughout the country.   

You ISOLATE when you are sick and have been infected by the virus.  

You QUARANTINE when you may have been exposed to the virus and may or may not have been infected even if you do not have symptoms.  

CDC Guidelines for ISOLATION:  Stay home and isolate from people for at least 5 days.  The day you developed symptoms is day 0.  Wear a well fitting mask around others at home and in public on days 6-10 if you are afebrile and have decreasing or no symptoms.  You can take a rapid test at that time, but it is not required. In a British study 31% of patients still had a positive test on Day 5, and 1% on Day 10, but rapid tests are not reliable for determining when an individual is no longer contagious.. .

CDC Guidelines for QUARANTINE:

If you come into contact with someone with COVID-19, and you are fully vaccinated AND boosted, you don't have to quarantine. 

If you are vaccinated, but not boosted, or you have not been vaccinated, you should quarantine for 5 days, followed by strict mask use for 5 more days. The incubation period for the virus is usually 3-5 days, but may be as long as 10 days.  See Below  

Isolation.QuarantineSIZE.jpg

When I was a child I distinctly remember having measles and chickenpox - one year APART.  My doctor came to our house to make the diagnosis and then put a big sign on our front door that the house was in QUARANTINE - by an old public health definition.  After I was no longer febrile and symptomatic, my mother and I went to the Department of Health and turned in the Quarantine sign.  Both of those highly infectious viruses are now controlled by vaccines that children get early in life.  Please vaccinate your children and grandchildren against COVID-19.  More children are getting Covid and more are hospitalized.  

January 5, 2022

Happy New Year and Covid Updates

Wishing You a Happy and Healthy New Year!  But we are in the middle of a huge surge in Coronavirus Cases and even fully vaccinated and boosted people can develop breakthrough cases.  These people, however are reporting mild symptoms, i.e. like a bad cold, and are rarely being hospitalized with severe disease.  Most of the hospitalized patients are unvaccinated.  Today one of my favorite epidemiologists said that neither cloth nor surgical masks are sufficient to block exposure to the omicron virus and recommended N95 or KN95 masks from this point on. 

I follow the daily infection rates for NY State, City, and Manhattan and we are in the middle of a surge that is worse than any other time during the pandemic.  On Nov 1st the Washington Post Covid Tracker said that NY State had 20 Covid Cases/100,000 people.  The infection rate was 0.7% in Manhattan, 1.0% in NYC, and 2.4% in NY State.  On January 1 the Covid Tracker showed 318 Cases/100,000 population, and the infection rates were 18.6% in Manhattan, 22.7% in NYC, and 23.4% in NY State.  When I take my early morning walk lines are very long for testing at multiple sites in my area.  For high risk patients with omicron infection there is only one monoclonal antibody treatment that is effective and that is in very short supply.  Neither of the recently approved drugs against the virus are available in any quantity - and the preference is for Paxlovid by Pfizer - based on efficacy and safety.  See Below 

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Vaccinations are making a huge difference and this week the CDC will approve booster shots for 12-15 year old children 5 months after their 2nd vaccine dose.  Hospitalizations and severe infections in children have increased and there are many children who should still be vaccinated and if fully vaccinated should be boosted based on the CDC recommendations.  On Saturday I'll review "Isolation" and "Quarantine" recommendations that are changing in order to safely shorten time out of work for essential workers. 

December 18, 2021

This Week's Covid News

The are two important announcements from this week.  

Pfizer published a press release on Paxlovid, their oral drug for treating early Covid infections.  It is an anti-protease that directly affects the virus by blocking SARS-Cov-2 replication.  Treatment consists of 3 pills every 12 hours for 5 days.  If taken during the first 3 days after onset of symptoms in high risk patients it can reduce hospitalization and death by 89% (5/697 treated patients were hospitalized with no deaths; 44/682 patients who took placebo were hospitalized with 9 subsequent deaths; (p<0.0001) . Relative risk reduction was 94% in patients 65+ years.  Adverse events were the same in the treatment group (22%) and placebo (21%) and were mostly mild to moderate.  If treatment was started within 5 days of developing symptoms the reduction was 88%. They are conducting the trial in standard risk patients as well.

The drug is likely to be active against the omicron variant because the drug blocks an enzyme in viral replication. This is different from the spike protein where the 30 mutations occurred.  See Below 

PfizerPillSIZE.jpg

On Thursday the FDA Advisory Committee met to discuss the blood clotting side effects (Thrombotic Thrombocytopenia Syndrome) that is a rare, but very significant side effect of the J and J vaccine.  The incidence is 1:100,000 but the cases that occurred since the initial FDA approval appear to have 15% mortality.  The mechanism for this serious adverse effect is being studied in many labs in various countries but no definitive discoveries were made.  The Advisory Committee unanimously approved the following statement:  "mRNA vaccines are preferred over the Janssen Covid-19 vaccine for the prevention of Covid-19 for all >18 years of age."

The J and J (Janssen) vaccine still should be used for patients who are allergic to the mRNA vaccines and in areas where the storage requirements for the mRNA vaccines would be difficult.  It is also recommended that 2 doses of the J and J vaccine be given for full vaccination.  

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