The best method of overcoming obstacles is the team method. - Colin Powell
Coming together is a beginning, staying together is progress and working together is success. - Henry Ford
Vaccination Updates: As of June 4 ,2021 (CDC) 44% of PA is vaccinated, 47% of New York is vaccinated and 49% of New Jersey is vaccinated. As of June 3,2021 (CDC) 41.2 % of the U. S. is vaccinated. Still short of the goal of 70% needed for Herd Immunity.
As of June 5,2021, there are 34,194,023 positive cases, 612,240 deaths and 28,054,995 recoveries.
This represents an increase of 169,366 positive cases over last week and an increase of 3,279 or 468 deaths per day over last week.
What are the risks to you and your kids when vaccinated and unvaccinated people mix? The Boston Globe spoke with three infectious disease experts to ask common questions about safety when vaccinated and unvaccinated people mix in a group. One question you may have: If I'm vaccinated, how high is the risk in hanging out with an unvaccinated person? "Very, very low," said Dr. Daniel Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital.
Experts say it's safe for most fully vaccinated people to enjoy their newfound freedom, but we still need to watch the data closely because "things can change on a dime," said Dr. Joshua Barocas, an infectious diseases specialist at Boston Medical Center.
COVID Long Haulers Illuminate Overlooked Medical Condition: Patient reports of "long hauler" symptoms after COVID-19 have compelled clinicians and researchers to pay closer attention to an often-neglected medical condition that could potentially result from the virus -- postural orthostatic tachycardia syndrome (POTS).
POTS affects the autonomic nervous system, and is characterized by the NIH as too little blood flow to the heart when patients move from a seated to upright position. While "textbook cases" of POTS present as heart palpitations and lightheadedness, symptoms can include brain fog, tiredness, exercise intolerance, chronic nausea, constipation, sleep disturbance, or metabolic dysfunction.
Between 1 and 3 million people in the U.S. are diagnosed with POTS each year. While anyone can develop the condition, women ages 15 to 50 are disproportionately affected. POTS is infamously difficult to diagnose, with the average diagnostic delay at more than 5 years. The reason for the delay in diagnosis for POTS is that many clinicians do not know much about it.
Natural COVID Immunity: Epidemiologists estimate over 160 million people worldwide have recovered from COVID-19. Those who have recovered have an astonishingly low frequency of repeat infection, disease, or death. That immunity from prior infection protects many people now where vaccines are not yet available. Numerous scientists have found that there is a decreased risk of re-infection and extremely low rates of hospitalization and death due to repeat infection. The range of reduction of re-infection from COVID-19 was between 82% to 95% among six studies that encompassed nearly 1 million people conducted in the U.S., the U.K., Denmark, Austria, Qatar, and among U.S. Marines. The study in Austria also found that the frequency of re-infection from COVID-19 caused hospitalization in only five out of 14,840 (0.03%) people and death in one out of 14,840 (0.01%).
Good News About the Longevity of COVID-19 Immunity: Emerging research shows that immunity to the novel coronavirus may last upwards of 1 year, especially among those who are fully vaccinated and have recovered from a COVID-19 infection. Two studies, one published in Nature, the other in BioRxiv, found that individuals who have recovered from COVID-19 infection and also received COVID-19 vaccinations will most likely not need a booster shot to maintain their immunity. Those who are vaccinated but were never infected with SARS-CO-V-2 will probably need a booster shot to ensure their immunity. Both studies found that cells still had memory of the novel coronavirus a year post-infection, enabling them to continue generating antibodies in response to an exposure.
COVID-19 vaccines could offer lasting protection without booster doses needed: Early clues indicate that existing COVID-19 could offer lasting protection without the need for booster doses. But studies to confirm these theories are underway. Pfizer and Moderna have both estimated that people may need yearly shots to boost their protection against the coronavirus, but some experts say they may only be needed every few years. "I would be surprised if we actually needed a yearly booster shot," said Dr. Paul Offit, a vaccine specialist at the Children’s Hospital of Philadelphia who advises the Food and Drug Administration.
COVID-19 Precautions Remain Necessary in the Dental Setting: With the lifting of restrictions for vaccinated Americans by the United States Centers for Disease Control and Prevention and the decision made by many states to strike previous safety guidelines related to the pandemic, many dental offices have wondered how these impact their practice policies. However, the California Dental Association (CDA) notes that the CDC’s easing of COVID-19 restrictions for vaccinated individuals does not apply to healthcare settings. The CDA asserts that dental offices should continue requiring patients, clinicians, and staff—regardless of vaccination status—to wear masks and maintain appropriate social distancing when not in the operatory; maintain the use of respirators when aerosol-generating procedures are performed; and continue COVID-19 patient screening protocols.
COVID-19 Treatments: What Works:
Remdesivir (Veklury), an antiviral, is currently the only FDA-approved therapy for COVID-19. It prevents SARS-CoV-2 from replicating by binding to RNA-dependent RNA polymerase, a key enzyme the virus needs to propagate.
Dexamethasone, a corticosteroid with potent anti-inflammatory effects, is recommended for use in many categories of patients hospitalized with COVID-19, but not for those with mild-to-moderate disease who aren't in the hospital.
Tocilizumab, an anti-Human IL6R Therapeutic Antibody in combination with dexamethasone in certain hospitalized COVID patients exhibiting rapid respiratory decompensation. That includes those who have been admitted to the ICU within the previous 24 hours who require invasive mechanical ventilation, noninvasive mechanical ventilation or high-flow nasal cannula oxygen.
Baricitinib, a Rheumatoid arthritis medication in combination with dexamethasone alone or dexamethasone plus remdesivir for treating hospitalized patients on high-flow oxygen or noninvasive ventilation who have evidence of clinical progression or increased markers of inflammation.
Anticoagulation: NIH recommends that all adults hospitalized for COVID-19 who aren't pregnant should receive prophylactic anticoagulation to prevent venous thromboembolism
Convalescent plasma has an FDA emergency use authorization to treat hospitalized COVID-19 patients. Only high-titer plasma is now authorized, however, and with restriction to hospitalized patients who are early in their disease course or those who have impaired humoral immunity.
Monoclonal Antibodies: NIH now recommends using either monoclonal antibody combination therapy in outpatients with mild-to-moderate COVID-19 who are at high risk for clinical progression.
Until next time Stay Safe, Stay Well, Wear your Mask wisely, and Get Vaccinated.
James A Vito, D.M.D.