HOPE: Noun; The feeling that what is wanted can be had or that events will turn out for the best.
Verb: To look forward to with desire and reasonable confidence.
By the numbers: There are as of Friday November 12,2021: 47,762,536 positive cases to date in the U.S. and 782,135 deaths to date in the U.S.. This is up 444,725 and 27,031 respectively over last week. And we have the Holidays coming up where experts suggest we may be due to a fifth surge due to the upcoming holidays.
With 7 weeks to go before the end of the year, if things remain the same and using current numbers this means a minimum of another 3,113,075 positive cases and another 189,217 deaths. This will bring the death total to 971,352+ by the end of 2021.
This would mean the 2021 death rate will be close to triple that of 2020 which was 377,883 according to the CDC.
It is up to us to control our destiny. Facts versus hype: The majority of people who are contracting and dying of COVID 19 are unvaccinated. This is based on information gathered by hospitals across the country. Breakthrough infections of vaccinated individuals occur in those with co morbidities such as immunologic disorders, breathing and lung issues, diabetes, obesity, heart, liver and kidney disease. Therefore, they need the Booster shot and possibly a fourth shot so that they are protected.
Natural immunity does occur if you have had COVID but this immunity varies depending upon how sick you get. The more affected by COVID you are the more immunity you develop. The less sick you get the less immunity you have. The science show those that have had COVID and get vaccinated develop a hybrid immunity which is much stronger than the vaccine alone.
We can expect more colds and flu this season as COVID restrictions lift. 5 germs to look out for:
1. Influenza: Usually seasonal influenza kills 290,000 to 650,000 people a year worldwide. But since COVID hit, it has practically vanished. The most likely reason for such a dramatic drop is the reduction in international travel. Public health interventions designed to curb COVID such as mask wearing, hand washing, physical distancing have also likely contributed. With global travel opening up again, influenza will likely travel too. So, we anticipate seeing a lot more of it around.
2. Streptococcus pneumoniae: Pandemic response measures have also curbed Streptococcus pneumoniae. A study was conducted on data from 26 countries across six continents in the first half of 2020. It found S. pneumoniae infections decreased by 82% after eight weeks of restricted population movement, such as lockdown. This bacteria cause’s pneumonia (which is how it got its name). It can also cause a range of other illnesses from ear infections and sinusitis to life-threatening infections of the bloodstream (sepsis), and central nervous system (meningitis). Young children, older people and people with impaired immune systems are most at risk. Thankfully, we have vaccines (known as pneumococcal vaccines) to help prevent the nastier diseases you can get from this bacteria. If you catch S. pneumoniae, it does respond to antibiotics. However, it’s resistant to at least one antibiotic in three out of every ten cases. Prevention (with vaccines and hygiene) is definitely the better option. So as a community, we must carefully steward our use of antibiotics to make sure they actually work when we really need them.
3. Neisseria meningitides: This is another nasty bacteria. You may have already guessed from its name that it can cause meningococcal meningitis, a serious infection of the central nervous system. The same international study that found a reduction in S. pneumoniae during lockdowns also found rates of Neisseria meningitidis greatly reduced. This is not surprising as N. meningitidis also lives in the nose and throat and can be transmitted from person to person via droplets as people cough and sneeze. Meningitis outbreaks have occurred worldwide over the years, and a high proportion of people who become sick with it die. Survivors sometimes have severe, lifelong disability. Like with S. pneumoniae, there is both prevention (via a vaccine) and treatment (with antibiotics) for N. meningitidis infections. But there is also growing antibiotic resistance. So, getting vaccinated, and avoiding antibiotic overuse, are important ways to reduce the risk of being seriously impacted by this bacteria.
4. Respiratory syncytial virus: Respiratory syncytial virus (or RSV) is a common virus causing a flulike lung infection called bronchiolitis. This mostly seriously affects children under the age of two. Although RSV infections usually cause mild cold symptoms, they are also responsible for a significant number of deaths in children under five worldwide. During COVID lockdowns around the world, RSV infections were at a historic low for a year. But they started rising again in April 2021. Doctors usually expect to see spikes of RSV in winter months, and before COVID many assumed this was because it survived and replicated better in colder weather. However, we now realize RSV is less dependent on colder temperatures in winter and Hygiene behaviors. So, for the sake of our little ones, we should not lose all the good habits we developed to combat COVID, such as staying home when sick, washing our hands, covering our coughs/sneezes and wearing masks in higher risk settings.
5. Rhinovirus continued to spread throughout the pandemic and infections even shot up in some countries. But I am including it in this list as its prevalence holds some fascinating potential in our fight against COVID. Rhinovirus, like RSV, is a major cause of the common cold, particularly in infants. Both rhinovirus and RSV show the same symptoms. So, without doing a diagnostic test it is impossible to tell which of these someone has. They require the same acute treatment anyway. However, recently there has been interest in distinguishing between them for two reasons. First, if a child has a rhinovirus infection in early childhood, they may have a higher risk of recurrent respiratory symptoms and a higher risk of developing recurrent wheezing and childhood asthma Second, there is the exciting potential for rhinovirus infections to actually train our immune system to block other viruses, such as the coronavirus and influenza. This is still in the early stages of research but is something to watch.
Take home message: We can reduce the impact of these five germs by keeping up simple hygiene habits, like washing hands frequently, getting immunized where possible, and making sure we only use antibiotics when absolutely necessary. However, if you do have respiratory symptoms as a result of easing restrictions, and as symptoms do overlap with COVID, you should get a COVID test.
Remember we are entering cold and flu season — and it is still COVID season!
HOW DO I NOT GET SICK? Like COVID-19, colds and flus are viruses. Getting infected with a virus as the pandemic has taught us so well depends on a few things: First, exposure. That could be through the air, a main method of transmission for COVID-19 and the flu, or by touching surfaces contaminated with germs shed by infected individuals which is the way colds are often spread. So last October, when children returned to school wearing masks and physical distancing, flu and COVID were kept at bay — but cases of rhinoviruses, which cause 10-40% of common colds, exploded. People who have been exposed to a virus in the past have more immunity to it. That's why kids tend to get sick more often than adults: They haven't had as much time to be exposed to a variety of viruses. So, it is possible that people will have fewer antibodies to this year's flu strain because of last year's general lack of exposure, leading to a bad flu season — but it's also possible that previous exposures have built up some levels of antibodies.
It's unknown how many antibodies we have to different viruses, points out Dr. Abraar Karan, an infectious disease doctor at Stanford University. "But we should still have some immune response to past strains," he says. And there's another way to build up antibodies: vaccines. That could make it especially important to get the flu shot this year, he notes. So, the challenge is: stay healthy and, if you fall prey to a virus, avoid infecting others.
This brings us to a topic we all are too familiar in the COVID era: washing your hands! "There's not really such a thing as being too clean," says Charlotte Baker, an assistant professor of epidemiology at Virginia Tech, adding that the pandemic was a wake-up call for many who don't wash their hands enough. "You should always keep your hands clean." Although you should avoid using antibacterial soap, when possible, for other reasons (such as developing antibiotic resistance, which doesn't affect viruses), it's fine to keep using alcohol-based hand sanitizers, she says. That does not lead to antibiotic resistance. Then there's the matter of not infecting others. That means staying home when sick and ... yes, wearing masks on occasion!
Children 5-11 starting to get vaccinated: Nearly 900,000 elementary school aged children have received their first dose of the COVID-19 vaccine this week with nearly 20,000 pharmacies, clinics and pediatricians administering the shots.
The CDC director Dr. Rochelle Walensky, says it's a step in the right direction to help protect more than just children's physical health.
"We have seen the ways this pandemic has threatened the social and emotional well-being of our children," Dr. Rochelle Walensky said. "For many children, school has been a safe and enriching environment. For this past year and a half, many children have felt the effects of school closures."
There are twenty-eight million five-to-11-year-olds who are eligible for the low-dose Pfizer vaccine.
How do the COVID antiviral pills work?: Last week I mentioned that 2 companies, Merck and Pfizer have developed anti-viral pills to combat COVID 19. The coronavirus wreaks havoc on the body by inserting itself into cells and hijacking their machinery to make copies of itself. The copies then burst out of the cells and invade other cells, spreading through the body.
The first drug, Molnupiravir from Merck, was done in collaboration with Ridgeback Biotherapeutics, is an antiviral originally developed to treat flu viruses.
Molnupiravir, is a polymerase inhibitor and works by stopping the virus’s genetic material from being replicated accurately. It fools the enzyme (called a polymerase) responsible for replicating the virus’s RNA so that it inserts errors, or mutations. The mutations then get replicated over and over, until there are so many mutations that the virus can no longer survive.
The second called Paxlovid was developed by Pfizer. Pfizer announced the results of its clinical trial of the antiviral Paxlovid and said it would submit its data to the FDA in the coming weeks.
Paxlovid, consists of two components: an experimental molecule called PF-07321332 and an existing drug called ritonavir. Both are protease inhibitors, which means they block a different enzyme (called a protease) that cuts apart long strands of nonfunctional viral proteins into smaller, functional proteins. PF-07321332 is the star of the show in the drug duo, working on the virus itself, while ritonavir stops other enzymes from destroying PF-07321332. Ritonavir plays the same defensive role in antiviral drug cocktails that treat HIV.
Molnupiravir and Paxlovid both aim to stop the coronavirus from replicating, but they use slightly different methods. Both drugs are designed to be administered as pills, have proven to be remarkably successful in placebo-controlled clinical trials in preventing hospitalization and death due to Covid-19. Experts are hopeful that authorization of the drugs will be a major step toward ending the Covid-19 pandemic.
In the clinical trials, Merck and Pfizer started the treatments within five days of symptoms’ starting. “These drugs can be administered at any stage of the infection based on their mode of action,” said Fenyong Liu, a virologist at the University of California, Berkeley. However, they will be more effective if they are given in the early stages of the infection, “because more severe complications and damage due to infection are always associated with later stages.”
“That is because the longer the virus has to make more copies of itself, the more it’s going to spread and cause problems. If the virus is stopped early, the consequences will be less severe”, says Katherine Seley-Radtke, a medical chemist at the University of Maryland, Baltimore County, who specializes in antiviral drug development.
The clinical trials for both treatments reported no unfavorable side effects that were any different from those of the placebo, which experts say is promising. The major advantage the new drugs have over existing Covid-19 drugs is that they come in pill form, rather than as intravenous drugs.
Until next time, Stay Safe, Stay Well, Practice Mitigation Factors including Mask wearing, washing your hands frequently and consider getting vaccinated if you have not already done so. This will make the difference how we end the year and gain control over COVID -19.
James A Vito, D.M.D.