We Must Protect Our Children…Get Vaccinated!

Covid-19 is surging in every state including Ohio. There were 3,393 cases reported in Ohio on Wednesday August 11th which represents the largest number since 3,305 were reported on February 12th. The seven-day positivity rate in Ohio is 7.7%, greater than 5% represents “high transmission” level. It should be noted that all sixteen counties in the Greater Cincinnati area have a level of transmission designated as “high”.  Hospitalizations are on the rise in Ohio, yet it remains the case that 98.4% of those hospitalized are not fully vaccinated. The Delta variant makes up 86.4% of the positive tests identified in the latest round of sequencing. The adult population of Ohio continues to lag behind the national rate of vaccination. Only 61% of Ohioans over age 18 have received at least one dose of a vaccination compared to 71% of US adults over age 18. The good news is that vaccinations are on the rise in Ohio. Roughly 8,200 shots were given on the first day of last week compared to 4,300 daily in the second week of July. Note that during March there was a daily average of 60,370.

Since the beginning of this pandemic our children have experienced less severe consequences from Covid-19. Unfortunately, as the highly contagious Delta variant has spiked in our country, the Children’s hospitals in multiple states including AR, FL, LA, MO, MS, and TX have become overwhelmed. Children are becoming ill in record numbers typified by the 71,726 cases reported in the USA last week compared to the 38,654 cases reported the previous week. Further information from the American Academy of Pediatrics (AAP) shows that children represented 19% of the cases reported during the week ending July 29 compared to 14.3% of the cases since the beginning of the pandemic. Unfortunately, death has visited 350 children since the beginning of the pandemic. Tens of millions of children have been directly affected by being out of the classroom due to the pandemic. They have suffered isolation and other affronts to their mental health. Additionally, the “educational gap” that already existed has dramatically increased. This is particularly the case for students in low-income and minority communities. Multiple surveys of educators have revealed that children in these communities have been disproportionately impacted. 

It is clear that our children need to be back in school. In-classroom instruction is a key to healing their mental health. Also, this action is necessary to arrest the widening educational gap and to implement measures necessary for closing the preexisting disparity. The impediment to their returning to in-class instruction is this viral scourge and its variants. There are about 48 million children in the US who are under the age of 12 and therefore not eligible for Covid-19 vaccination. Studies are ongoing which will determine the safety and efficacy of the vaccines in these children. We cannot allow our need to have vaccines available for children under 12 to supersede the proper scientific precautions being followed, before they are released. 

There remain widespread concerns about the safety and efficacy of the current vaccines. May those who claim concern about the current EUA status be comforted by the safe administration of billions of doses worldwide and by the 360M-plus shots safely given in the US. Additionally, after considerable study, the Pentagon is mandating vaccination for all active-duty forces. They understand that vaccination is part of “force protection” and the benefit to our fighting women and men far outweighs the minimal risk from the vaccines. Another indicator of vaccine safety and effectiveness came today with the CDC recommending that all pregnant women get a Covid-19 vaccination to protect themselves and their unborn. 

We must do all we can to protect our children’s safe return to school. We can achieve this by the unvaccinated teens and adults getting vaccinated. Secondly, by following the CDC guidelines of everyone wearing masks indoors in high transmission areas. Additionally, Covid-19 testing, although not an ideal substitute for vaccination, should be used more extensively. Lastly, we can help ourselves by following CDC guidelines for social distancing of three feet for children in school, along with masking and appropriate ventilation in classrooms and indoor spaces. 

We need to beat this virus and its current variants now. Further delays will allow the emergence of new variants which almost certainly will be less amenable to our current vaccines. At this time, the safest ticket for getting our children back into the classroom is teen and adult vaccination!

Our Labor Against Covid-19 Yields Inadequate Results!

Shortly after Labor Day of 2020, the question we asked was “Will YOU take the COVID-19 Vaccine?”.  At that time, we had lost 191,000 Americans and 6.4 million US cases had been diagnosed. A CBS/U.gov poll revealed at that time that only 21% of voters said they would take a COVID-19 vaccine as soon as it became available. Fast forward to Labor Day, 2021 where we have three safe and effective vaccines and yet 25% of eligible Americans have not been fully vaccinated. The seven-day new case average this Labor Day (9/6/21) was 300% higher than the last holiday of the last summer.  There have been 40 million cases in the US and 655,389 American deaths since this pandemic began. The data shows that these devastating trends are accelerating with daily hospitalizations having increased four-fold since the beginning of the summer of 2021 and deaths per day have more than tripled, 594 vs. 1561. Over 90% of these cases, hospitalizations, and deaths are PREVENTABLE since they are occurring in the unvaccinated! We now have vaccines available. 

The push to get people vaccinated is designed to allow us to return to more of a normalcy in our economic, educational, family, and leisure lives. One of the mainstays of this effort is keeping our children back to in-classroom instruction. Since our school kids have not been surrounded by vaccinated individuals, their classroom experiences are again being disrupted. Across the nation, 1400 schools in 35 different states have had to temporarily shut down. In Kentucky 20% of the schools have closed at some point since reopening this year due to infections, quarantines, or Covid induced personnel shortages. In addition, 25% of the new cases are in children. We are not doing our part in protecting the kids who are under 12 and thus not able to be vaccinated. 

Although access to a vaccination is not an issue for Americans 12 and over, only 75% of that population has availed themselves to this protection. Misinformation and disinformation are driving too many citizens to remain unvaccinated. Both of these categories are false information, the former being unintentional and the latter being the intentional and malicious misleading of others. The subject of “information” in both categories generally revolves around vaccine development, effectiveness, safety, and all too often outright denial.  Knowing that our ticket out of this pandemic is through vaccination, our country needs for the unvaccinated to change their course and get their shots. This is their pandemic but their being unvaccinated affects all of us. We must listen to their objections, process their motives or rationale, and then give them the facts.  Nothing more perfectly typifies dis/misinformation than the current controversy regarding ivermectin. This drug is approved for human use, in appropriate doses, for very specific parasitic diseases.  It is much more commonly used in higher doses in large animals like horses and cattle. Unfortunately, many of the purveyors of vaccine misinformation have erroneously latched onto this drug as a treatment for Covid-19. This has resulted in delays in vaccination and the legitimate treatment of those infected. Studies and statements from organizations like the AMA, FDA, and CDC have revealed that ivermectin is not beneficial against Covid-19. We must continue to labor to overcome the acceptance of politically motivated dis/mis-information over the demonstrated safety and effectiveness from hundreds of millions of vaccinations. 

The scientific community has provided us with tested and researched means of fighting this Covid-19 disease including vaccines, masks, monoclonal antibodies, corticosteroids, social distancing, and other mitigation measures. Yet we can only shake our heads at the maskless crowds already seen this fall in college football stadia. Some medical experts are warning of a phenomenon called a “multidemic” as the post Labor Day Covid-19 surge is added to seasonal flu and colds. Covid-19 mitigation measures, such as masking and social distancing prevented thousands of influenza deaths last year. Politicians and politics are preventing the reimplementation of these mandates. 

We must take matters into our own hands by following CDC guidelines. Mask while in crowds indoors, irrespective of vaccination status, and avoid large crowds of potentially unvaccinated folks.  WASH your hands and get your flu shot when it becomes available.

The Delta Variant.. A Different War Against Covid-19

As the information about this SARS-Cov-2 virus that causes Covid-19 evolves, so must the measures that are recommended to fight this scourge. It is clear science that this virus will not mutate unless it can proliferate.  The Covid-19 case numbers in our country have increased from 15,000 on the first day of July to 97,000 on the 1st of August. The USA is in the throes of another peak as Covid-19 cases have increased 54% in the last week. Hospitalizations and deaths are again on the rise, mostly in states with low vaccination rates.  Five states (CA, FL, LA, MO, and TX) have 46% of the current new cases of Covid-19. Florida has 20% of the total number of current cases in the USA and has a positivity rate of 18% (rate above 5% is considered “too high”, Johns Hopkins U.).  Over 99% of the current deaths and 96% of the hospitalizations are occurring in people who are not vaccinated. The Delta variant has exploded in the USA as a result of the political stubbornness,  depressed vaccination rates, the social and business reopening of our country, and the huge misinterpretation or disregard for the CDC mask guidelines released in May, 2021. The CDC declaring that fully vaccinated individuals could go without masks in most circumstances was used as a counterproductive license for the unvaccinated to go out in public without masks in every situation.  

The Delta variant has thus continued to thrive. New information regarding this very prevalent variant shows that it is more transmissible than chickenpox, seasonal flu, Ebola, and SARS. An alarming CDC study out of Massachusetts published July 30, 2021 at cdc.gov/mmwr detailed 469 Covid-19 cases in individuals who had traveled to and attended large public events in a town in Barnestable County, MA. between July3-17, 2021; 74% of the cases occurred in fully-vaccinated individuals. The Delta variant was identified in 90% of the specimens tested.  The good news is that only four of the 469 patients were hospitalized (1.2%) and there were no deaths reported.  

As a result of the Barnestable incident, the CDC’s tracking of over 6000 breakthrough infections, and emerging data showing vaccinated and unvaccinated persons having similar nasal viral loads, the CDC has revised its mask guidelines for vaccinated individuals (cdc.gov). The guidelines for the unvaccinated remain the same that is, until you get vaccinated, WEAR a mask at all times when around others especially indoors and maintain social distancing. Because of the Delta variant and to reduce the risk of spreading the virus indoors it is now recommended that even the fully vaccinated wear masks indoors when in “substantial or high transmission” areas. These areas are broken down by county on the very easy to use and constantly updated CDC COVID Data Tracker. Hamilton County in Ohio and all three adjacent Ohio counties are in the “substantial” category and all of the neighboring IN and KY counties are either “high” or “substantial” (8/1/2021).  So if you live in these counties and are fully vaccinated the Guidelines indicate that you should be masked when around others indoors! 

It cannot be overstated that our way out of this pandemic is through vaccinations. We just reached President Biden’s goal of 70% of adults with at least one vaccine dose. We need 75% vaccination for the entire country to get US to the immunity necessary to crush this virus. Fortunately, vaccination rates are increasing as over 700K Americans daily have rolled up their sleeves for the last five days, and 816K a couple of days ago. Contributing factors to this increase probably includes concern about the Delta variant and the mandates to their employees and customers by private businesses such as Disney, Walmart, and Broadway theaters. 

In order to win this war against this novel Covid-19, and we will; we must be adaptable.  As the scientific knowledge changes so must we. There will be Americans among us who will not accept any science for their variety of reasons, yet as healthcare workers we will provide information to the majority.  We encourage every eligible American to get VACCINATED with one of the available, safe, and effective vaccines. Please WEAR your masks in accordance with CDC Guidelines.

COVID-19- The Pandemic of the Unvaccinated

Unfortunately, the unheeded concerns that we have been voicing are coming to fruition. With the lifting mandates, the emergence of variants, and the dramatic slowing of vaccination rates Covid-19 cases are skyrocketing in every state except two (SD & WY). Across the country over the last week, cases are up 74%, hospitalizations have increased 46%, and deaths are up 26%. Cases in Los Angeles County are up 300% in the last 3 weeks. Forty states have seen 100% increases in the last two weeks.  A total of 606,618 Americans have died from this virus. Most current deaths and hospitalizations caused by Covid-19 are preventable!  It is compelling that 99% of the US Covid-19 hospitalizations and deaths occurring in the US are in the unvaccinated. It is alarming that it is summer and cooler weather will bring further increases.  

The adults who choose not to be vaccinated are leaving themselves vulnerable to the currently rampant Delta variant. This variant now makes up 83% of the Covid-19 infections in the USA. That percentage was 50% less than two weeks ago.  If these statistics are not convincing enough, maybe some will be moved by the following emerging science. This Delta variant is the most contagious variant across the world.  It spreads 225% faster than any other version of the virus.  Research shows that the actual number of individual viruses produced in the body of a Delta variant victim is 1260 times greater than the original strain. Patients infected with the Delta also develop detectable levels of the virus in their bodies at day four after infection as opposed to day six (6) for those who developed infection caused by the original (Alpha) strain. The current round of hospitalizations is occurring in younger people, and they are requiring more ICU care. 

So, we ask “what about the children?”. Unvaccinated adults are putting children under the age of 12, who are not eligible for vaccination, at extreme risk for the Delta and other generations of variants yet to develop.  There are currently 100M Americans who have NO immunity which includes children under 12 years old. New variants cannot develop if we decrease the number of people susceptible.  We have the means to decrease the number of susceptible if only the eligible unvaccinated people would simply take one of the safe, effective, and available vaccines. It is likely that it will be 3-6 months before there is approval of the vaccines for the children under age 12. We must protect our children who need to be back in face-to-face school instruction. The CDC has declared that kids should be in school and masked if not vaccinated.  While children are in school, social distancing of at least 3 feet should be maintained. 

Another consequence of people choosing not to get vaccinated is that “breakthrough infections” are occurring on an increasing basis. The good news is that if you have been fully vaccinated and then test positive you are less likely to be contagious and are likely protected from severe disease, hospitalization, or death. You may be asymptomatic.  One might ask how can a vaccinated person get reinfected?  The answer is that no vaccine is perfect so there is a small number of people who are susceptible. Add to this the much larger number of people who have chosen not to get vaccinated and those children who are not eligible then it remains easy for the virus to find a new victim. In the process of infecting new people, the virus mutates. Thus, we see variants eventually less susceptible to the vaccine. We can easily break this chain of events if eligible adults would make the choice to become vaccinated. Some Fortune 500 companies and governmental entities such as NYC health are giving workers the choice of getting fully vaccinated or getting tested daily as a condition of work. Incentives have not been universally effective so consequences of the choices may be helpful. 

America was subjected to the Alpha strain last year, the Delta strain this year, and if so, many people are not getting vaccinated there will be a different strain next year. The proliferation of these variants is preventable!  Just get vaccinated!!

Get Vaccinated…The Delta Variant Won’t Wait!

With every passing day in our Covid-19 pandemic discussions we hear more and more about the Delta variant.  This mutation referred to as Delta was first discovered in India and now represents the dominant strain being isolated in the USA (over 50%).  The Delta variant is in all fifty states. It is said to be 70% more contagious than and three times as deadly as the original strain of the SARS-Cov-2 virus. The science and practical experience is that a virus cannot mutate unless it proliferates.  The virus wants to live so it adapts itself to changes in the environment in which it lives. If the virus cannot find a susceptible host then it will not change and in fact it will die in a society since it cannot spread.  The more people who are vaccinated, the harder for the virus to find another host.  This scenario is clearly being born out in our country as the states with the least percentage of vaccinated individuals are also those states that are seeing the greatest increase in the virus. This will only get worse as cool weather approaches, more of these unvaccinated folks go without masks, and our country continues to re-open.  

The consequences of Covid-19 vaccine hesitancy are becoming more and more apparent as 99.2% of American deaths from Covid-19 are in the unvaccinated. Hospitalizations with ICU stays and ventilator usage are increasing in Utah and Missouri, both of which have vaccination rates under 40% compared to 48% of Americans being fully vaccinated. Counties in rural America with the lowest vaccination rates have the fastest rises in cases. In southwest Missouri the hospital administrations are reaching out for extra respiratory therapists, physicians, and nurses because the hospitals are being overwhelmed. Federal government surge teams are reporting to hotspots as civilian volunteers are also arriving. This is what we say early in the pandemic.  We have two recent examples of outbreaks associated with not being vaccinated. The Illinois Department of Public Health recently reported 85 cases amongst teens and adult staff at a central Illinois summer camp. One of the campers required hospitalization. Only a handful of the infected had been vaccinated. Two of the campers also attended a conference which resulted in 11 additional cases, 70% of whom had not been vaccinated.  Secondly, a Texas church summer camp (6th through 12th grade) was found to have 125 cases, some of which were Delta variant.  Only 3.7% of the infected people had been vaccinated. The outbreak swelled to 160 case once these children had returned home. 

Even though most of these Covid positive young people did not become significantly ill, it cannot be overstated that those folks with whom they come in contact are susceptible to becoming ill especially if they are immunocompromised and/or unvaccinated. We must also keep in mind that even those who exhibit only mild symptoms may develop long term dysfunction of various organ systems. 

Up until recently data has shown 90-95% effectiveness of the Pfizer vaccine against the Delta variant. Unfortunately, a newly released Israeli study reveals a 64% effective rate against the variant but still 95% effective at preventing death, hospitalization, and severe disease. Data out of Israel has shown that there is a two-fold case reduction derived for every 20% increase in the number of people vaccinated. It is simply stated that our best defense against Covid-19 is getting vaccinated.  

We are becoming “two Americas” now in a Covid-19 sense.  The dividing line is whether or not a person has been vaccinated. The unwillingness of certain parts of the population to get vaccinated is accompanied by those same individuals being unwilling to follow recommendations that are designed to protect them from the ravages of Covid-19, such as wearing masks and social distancing.  The other America, where vaccination rates are high, is safely getting back to normal with the restaurants reopening, sporting events moving to full capacity, and grandparents safely hugging their grandchildren, etc. 

As healthcare providers we know which America we want everyone to be a part of. Please get vaccinated for you own benefit as well as for your family and our country. If you are unvaccinated wear a mask and continue to socially distance indoors!

If YOU are not fully vaccinated…WEAR A MASK!

Yes, we are all tired of wearing masks. Most of us diligently wore our masks for almost 15 months. We still need to be paying attention. CDC Guidelines (CDC.gov/coronavirus) state that “If you are not fully vaccinated and aged 2 or older, you should wear a mask in indoor public places”. The individual states are empowered with mask mandate implementation and most had a mandate at some point during the last 15 months. Unfortunately, when these mask mandates were lifted so was the compliance with the CDC recommendation that unvaccinated citizens not only continue to wear masks in public while indoors, but also to continue to socially distance, and to avoid large crowds. There is maskless-ness everywhere! Ohioans are not heeding the repeated recommendations of Governor DeWine despite his press releases such as June 1, 2021, when he specifically stated that it is “important to get vaccinated…. those not fully-vaccinated should wear masks indoors and continue to socially distance”. The peak consequence of this disregard is not being seen yet. 

Since the beginning of the pandemic the hope has been that Americans wearing masks would help provide protection until we reached the approximately 75% vaccination level necessary for herd immunity.  Only 46% of the population has been fully vaccinated. At this time, approximately 67% of adults have received at least one vaccination. This represents roughly 54% of the population of the USA.  The pace of vaccinations is slowing as demonstrated by the 7-day running vaccination average peaking at nearly 3.4 million per day in early April and decreasing to about 700,000 per day as of June 17, 2021. Unfortunately, 1 of 10 people have not come back for their second dose. The vaccine effectiveness data shows that the three vaccines available in the US under Emergency Use Authorization are significantly effective against the original SARS-Cov2 virus. Slowing vaccinations, abandonment of masks, cooler weather, and the reopening of our society will be fertile environment for the rise in variants. The Delta variant has doubled in the US in the last week and now represents over 25% of the Covid-19 viruses isolated and is present in 49 states. Some good news from Israel and Great Britain is that the current vaccines have up to 90% effectiveness. 

There remains a great deal of resistance to Covid-19 vaccinations despite incentive programs such as Ohio’s Vax-a-Million, product giveaways, time off work, etc. A study from the Kaiser Family Foundation discovered that one third of the unvaccinated indicate that they are likely to get vaccinated once there is formal FDA approval is granted.  All three vaccines being used in the USA are under Emergency Use Authorization. Both Pfizer and Moderna have requested formal approval for their vaccines, but this process may take up to 6 more months. Another 12% of the unvaccinated are in the “wait-and-see group, most of these are young and Black. Approximately 7% of the unvaccinated say that they will get vaccinated if mandated by their employers. Employers and the US military are hesitant to mandate the vaccine as a condition of work, until the formal approval has been granted. Many colleges are mandating vaccination as a condition of on-campus instruction. Many of the unvaccinated are also concerned about the safety of the vaccines. There has been recent attention to the rare occurrence of myocarditis and pericarditis after vaccination (400 cases out of hundreds of millions of vaccines administered). These conditions are one hundred times more likely to occur if you catch Covid-19!  

Throughout this pandemic, the US has followed the British Covid-19 trends by 4-6 weeks. We should be cautious and concerned because Great Britain, where the Delta variant is the dominant strain, has extended its Covid-19 restrictions for another month.  Additionally, Israel has reinstated its indoor mask mandate, Australia has announced a two-week lockdown, and the World Health Organization is recommending that even the vaccinated should continue to wear masks indoors.  Los Angeles authorities are recommending that masks be worn indoors in public for unvaccinated as well as vaccinated individuals. 

This pandemic is not over folks! The CURRENT recommendation, which clearly is subject to change, is that if you are unvaccinated, please WEAR your mask.  For all of us, WASH your hands, WATCH your distance, and get vaccinated.

Folks…Covid-19 Is Not Over Yet

Our country has just celebrated a Memorial Day weekend that was so sorely missed when it was abandoned last year due to the raging pandemic.  Our ability to safely travel and participate in cookouts has been hard earned.  This improved level of our activities is consistent with the improvement in the COVID-19 numbers. The seven-day case average on June 1 was 17,119 which represents a 45% decrease over the last 14 days. Hospitalizations are down another 22% over the last 14 days. There were 356 USA deaths on June 1, representing a 44% decrease. Locally in Hamilton County we are doing marginally better, typified by the case positivity rate being down to a “high risk” level of 3% (recall that less than 5% is the threshold).  There have been numerous days in Hamilton County over the last 2 weeks where we have experienced zero deaths. Yet there remains a significant difference between safe activities allowed for the vaccinated versus those who have not rolled up their sleeves.  If you are not fully vaccinated, you should still be wearing a mask indoors when around people, avoid nonessential travel, continue 6 feet social distancing, and avoid crowds. Compare this to the safe freedoms allowed for the fully vaccinated, who no longer require masking or distancing in most circumstances (CDC.gov/covid). 

We are continuing to get especially important updates from our scientists which helps us regarding conducting our daily lives. Many parents will be comforted by the new Guidance for Operating Youth Camps from the CDC (May 28, 2021).  This information pertains to every variety of youth day and overnight camps. Because the vaccines are safe and effective and EUA has been granted for the Pfizer vaccine for children aged 12 and over, everybody in these age groups should be vaccinated.  If everyone at the start of a camp is fully vaccinated then NO masking, distancing, or capacity restrictions are necessary, except as required by federal, state, local, or tribal governments. (Imagine the implications for in person schools if everyone is fully vaccinated!). Irrespective of vaccination status masking is not necessary outdoors.  Yet indoors masking is recommended for camp participants who have not been fully vaccinated. 

We are at this better place in Ohio because of the nation’s aggressive vaccination development program and the massive distribution and administration program over the last 5 months.  There have been 137 million Americans fully vaccinated to date.  Just over 50% of adult Ohioans have been fully vaccinated, including over 75% of Ohioans over age 65. Because the currently unvaccinated Ohioans will be harder to reach, Gov. DeWine has initiated a Vax-a-million program. This incentive program has resulted in an over 20% increase in vaccinations and two $1 million awards and two 4-year Ohio college scholarships. These incentives are now being mimicked and expanded in other states and around the country. 

On June 2, President Biden announced his plan to get more people vaccinated. June has been declared a “Month of Action” with the goal of getting 70% of Americans at least one shot before the 4th of July. This is a multi-pronged approach involving government, business, entertainment and sports entities, community organizations, and trusted community voices. The plan helps to remove obstacles by providing transportation to vaccinations sites and providing childcare while people get vaccinated.  It incentivizes businesses to allow vaccination time off to employees by providing the business with tax credits. Vaccination sites are being placed at businesses, sporting events, and places where the people are. Free tickets to professional sporting events, meals, and even beer is being offered as incentives to get people vaccinated. It is proper to pull out all stops so that our country will be protected by us reaching the threshold of herd immunity. 

Americans have died and suffered too much, lost too many jobs, spent too many hours on virtual platforms, and kept our kids away from their teachers too long to stop our fight now.  Yes, there are people who will never get vaccinated but there are still many unvaccinated Americans who will get their shots as long as the vaccinated and our governments continue to inform, encourage, and remove the barriers and obstacles. Freedom summer is on the horizon!

Will Your Fellow Americans Be Honest About Having Been Vaccinated?

It was a great day and turning point in our fight against COVID-19 on May 13 when the CDC announced its new mask policy.  This new guidance comes in the contest of continuing great news in the USA regarding this deadly pandemic.  The May 16th Covid-19 USA case count was 16,616. This represents a 33% decrease over 14 days.  Deaths were 291 (a 13% decrease) and hospitalizations where down 17% to a continuing manageable level of 34,004.  This level of improvement is a direct consequence of the massively effective, yet unfinished, vaccination program.  There indeed is more work to be done!

The new guidance is very straight forward in spite of the characterizations of many in the national media.   The bottom-line is that all of those who are fully vaccinated no longer need to wear masks or physically distance outdoors or indoors except where mandated by governmental regulations or by the rules of individual businesses or workplaces. For the sake of clarity, remember that a person is defined as “fully vaccinated” two weeks after they have received the second dose of their Moderna or Pfizer vaccine or two weeks after the one required dose of the Johnson&Johnson vaccine. If you are fully vaccinated your path to normalcy is now so much clearer.  The full scope of the guidance is available at cdc.gov/coronavirus/2019 under “When You’ve Been Fully Vaccinated”.  Additional key points are that the fully vaccinated no longer need to self-quarantine or be tested before or after domestic travel.  Their international travel is more convenient as well since the guidance indicates that they no longer need to be tested before leaving the US (unless required be the destination country) and quarantining upon returning to the US is no longer necessary. They no longer need to be tested or self-quarantine, as long as they remain asymptomatic, after a known exposure to a Covid-19 positive person (and as long as they are not an employee or resident of a correctional facility or homeless shelter). People who are immunocompromised should consult their private physician before ditching their masks. 

One might ask what prompted the CDC to issue such a relieving guidance to Americans.  We can rest assured that the relief from masking for the fully vaccinated is based on the solid science of several studies of results after vaccination. One study published in the Journal of the American Medical Association analyzed nearly 5000 healthcare workers. It showed the vaccine to be 97% effective at preventing symptomatic Covid-19 and 86% effective at preventing asymptomatic infection.  The studies show that people who have been fully vaccinated are not likely to spread the virus. Since getting the virus and spreading the virus are less likely if you are fully vaccinated, then mask wearing is no longer necessary.  Be reminded that there are “break-through” infections that have been identified in people who have been fully vaccinated. This circumstance is known to have occurred in less than 10,000 cases out of the approximately 120 million Americans fully vaccinated. 

Clearly people who have been vaccinated are benefiting from the earned privileges of less masking.   A major concern is that Americans who have not earned the privileges will claim the benefit. We are now depending on an “honor system” to be confident for Americans to remain masked when they have not been vaccinated. Government, at all levels, and some businesses are showing reluctance to demanding proof of vaccination.  Many employers and educational institutions may not be so lenient, and thus demand proof of a person’s vaccination declaration.  Although the concept of a “vaccine passport” is repulsive to many, research out of the University of Louisville reveals that 25% if people lie about consequential things often and many people lie daily.  Actual research reveals that people are more likely to lie when the incentive is greater and the risk is lower.  Those who lie and go maskless are more likely to contract and spread Covid-19.  We all bear the brunt of their individual decisions they also delay the total safe reopening of our society.  If you have not been vaccinated, please do so and in the meantime be honest and WEAR your mask.

Fighting COVID-19…57% Just Won’t Do!

There is palpable optimism in the American air as evidenced by the over 1.7 million Americans traveling by air on yesterday. Happy Mother’s Day to all those brave women who have guided, worried, and loved us through this 14-month pandemic. While we mourn the 581,756 people who are no longer with us in the USA, we can celebrate that the running 7-day average of deaths has remained below 700 for at least the last 3 weeks. Average 7-day % positivity is down 8.5% compared to the previous week. Cases of Covid-19 are trending downward as well having dropped 13.2% to 45,817 (7-day average). Hospitalizations continue to trend downward as well showing an 8.4% decrease in the 7-day average compared to the prior week. To put this in context we cite the 4,640 hospitalization 7-day average compared to the 16,473 average on Jan 3-9, 2021. Our ICU occupancy rate with patients infected with the SARS-Cov-2 is well below 30%, so they are no longer under occupancy stress. Americans, particularly those mostvulnerable to the severe ravages of Covid-19 flocked to get vaccinated. The result of this momentum is 8 of 10 people over the age of 65 have been fully vaccinated. At least 149.5 million Americans have received at least one dose of a vaccine. The “fully vaccinated’ number in the USA is 108.9 million (100.3 million Moderna or Pfizer, and 8.6 million J&J). Yet only 57% of adult Americans have been fully vaccinated. This percentage of vaccinated is weighed down by only 1 in 3 people ages 18-29 having received shots and by political, cultural, and historical hesitancy. It is acknowledged that we will need to eventually vaccinate adolescents and even most younger children. This effort can now go forward since today, May 10, 2021, the FDA has granted Pfizer the Emergency Use Authorization for ages 12-15 for its mRNA vaccine. Clinical trials to assess the appropriate doses, safety, and efficacy for Moderna, J&J, and Pfizer for all children are ongoing.

Addressing the residual hesitancy concerns of the unvaccinated is indeed a multifaceted challenge. In this space we have previously chronicled many of the deterrents to vaccination in the Black community. The impact of the historical mistrust of the medical community, mixed messaging from the federal government, and the counterproductive moniker of “warp speed” has been dramatically lessened by real information delivered by trusted voices. Specifically, back in December 2020 fifty-two percent of Black Americans polled voiced a “wait and see” attitude and 20% said they would get the shot as soon as possible. Compared that to now where 59% of Blacks stated that they had already received a vaccine or would do so ASAP, and only 19% voiced a “wait and see”.

Every person who refuses to get vaccinated keeps US another step away from getting to herd immunity. The current 57% level of adult vaccination is far short of the 75-80% of the population necessary for herd immunity or the July 4 th 70% adult vaccination goal of President Biden. These goals will be aided by some people’s skepticism being eliminated by Pfizer seeking actual licensing for its vaccine since there is now six-month safety data available in tens of millions of recipients. Getting more people vaccinated soon will not only lessen the illness, hospitalizations, and deaths but also get all our kids back into the classroom and our society back to worship, work, concerts, sports, and socialization. By reducing virus replication we reduce the opportunities for the virus to mutate. Virus mutation is becoming more of a problem for the world. India is suffering now from what the USA experienced this past winter. Thousands of people are dying there every day and that country accounts for 46% of the world’s new cases. An India variant, classified by the WHO as B.1.617, has been identified which spreads more easily. There are five “variants of concern” in the United States and notably 60% of the new cases in our country are caused by the B.1.1.7 (British variant). In order to end a global pandemic the disease must be fought everywhere. In order to save our health and the world’s economy we must do more.

THE Reward for Getting the Shot!!

Two especially important and impactful events related to our fight against the COVID-19 virus have occurred within the last few days.  Three days ago (4/24/2021) the CDC Director signed off on the restart of Johnson & Johnson COVID-19 vaccination after approximately an 11 day pause.  The fact that this pause was recommended should give us confidence that the monitoring systems, designed to provide long-term information regarding the safety and efficacy of these vaccines which have been given Emergency Use Authorization, are working efficiently.  During this pause, the CDC was able to identify 15 people with the thrombosis/thrombocytopenia syndrome. There were three deaths and six hospitalization out of nearly eight million people injected.  All patients were between 19 and 58 years old with the vast majority being ages 18-48. This pause also allowed for physicians to be cautioned about the nuances of treating this rare complication.  The committee responsible for the monitoring the result of ongoing vaccine safety and efficacy (Advisory Committee on Immunization Practices (ACIP)) decided that the benefits of the vaccine far outweigh the risks. The restart of the vaccine was implemented with a warning that this rare complication can occur. The FDAs new guidance places emphasis on J&J vaccinees seeking immediate medical attention if they develop severe headaches, shortness of breath, severe leg, or abdominal pain, or petechiae (tiny brownish red dots/rash from bleeding beneath the skin) away from the site of vaccination. The new advisory also emphasizes to healthcare providers that non-heparin blood thinners should be used to treat this disorder when recognized.  

The second impactful event pertains to the upgrading of policies for those Americans who are fully vaccinated.  COVID-19 cases have slowed to approximately 51,000 per day, hospitalizations remain high at about 86,000 daily, and death rates have slowed to under a thousand per day, with a total of 574,313 since the beginning of the pandemic.   Vaccinations represent our way out of this COVID-19 peril.  So many Americans have responded to the call resulting in 232 million doses having been administered since Dec. 14, 2020.  Over 96 million Americans have been fully vaccinated, representing nearly 29% of the total population and 65% of citizens over age 65.  We are now getting more of our just rewards as the CDC announced that fully vaccinated people do not need to wear masks when outdoors, except when in crowded venues or settings. This means that fully vaccinated individuals from different households can gather or dine together outdoors. They can also attend a small gathering outdoors with unvaccinated individuals. Recall that several weeks ago the CDC declared that fully vaccinated people did not need masks when visiting another unvaccinated household of low-risk individuals without masks. Previously, two households of vaccinat6ed individuals could also meet indoors without masks. There is also great news for Americans wanting to travel to the European Union can do so without testing or quarantine if they have been fully vaccinated.  It should be noted that most indoor activities still are safest, even for the fully vaccinated, with a mask being worn. There is a myriad of specific guidelines available at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.  

The two issues detailed above should have effect on vaccine hesitancy. We need to get 80-85% of Americans vaccinated to reach levels of immunity that makes spread of the virus problematic.  Unfortunately, the J&J pause may give additional “pause” to the reluctant. As time goes on and safe utilization continues, the advantages of this one-dose vaccine will outweigh the perceived risks. There are other rational and irrational reasons for not taking one of the vaccines. Among these is political leaning, typified by 40% of Republicans saying they will never get vaccinated.  Curiously, half of frontline healthcare workers declare unwillingness to get the shot. The new CDC guidance has given incentives to the bunch that asks “Why should I get a COVID-19 shot if my lifestyle activities will not change? Sensitive and understanding information must be provided to influence those still resistant that protecting lives, livelihoods and lifestyles will be achieved by getting vaccinated.  

The happiness on the face and relief in the eyes of the newly vaccinated is a sight to behold! Join the ranks if you have not already.

PEOPLE! Hang on Just a Little Longer

Americans’ impatience is showing and is occurring as our COVID-19 cases are rising in the US.    We are on the cusp of getting enough Americans vaccinated to provide our country enough collective immunity to get back to a reasonable normal.  There is so much great news on the vaccine front.  According to our CDC 154 million vaccines have been administered in the United States. We are averaging nearly 3 million shots in arms daily.  The Biden administration goal of every adult in the US being eligible for vaccination by May 1 is well within reach.  As of March 29, Ohio Governor Michael DeWine has lowered the eligible age for getting vaccinated to 16 years old.  Recall that the three vaccines, Pfizer, Moderna, and Johnson & Johnson, which have received Emergency Use Authorization (EUA) are being administered in the USA at this time, at a combined clip of about 3 million per day.  They were given EUA because the data developed from large group usage was short term, having been studied for only two months.  These initial study groups have now been observed for six months, coupled with the tens of millions of Americans who have now been vaccinated. The updated information from Pfizer is that their vaccines are 90% effective for at least six months at preventing symptomatic COVID-19 disease and even better against severe disease. They have also been shown to be effective against the UK (B.1.1.7) and the South African variant (B.1.351). Additionally, recent information from Pfizer is that their vaccine is 100% effective in children between 12 and 15 years of age. EUA for this age group is likely to be requested “within weeks”. A multicounty safety and effectiveness vaccine trial for the 6 months to 11-year-old age group has also recently been launched by Pfizer and its partner BioNTech.  This progress means that vaccinating all our children is on the near horizon.   Imagine their safely returning to daycare and school, and their parents being able to return to work!  The last piece of great vaccination news is that vaccinated pregnant and breastfeeding women past protective antibodies on to their newborns and through breast milk. 

Despite all this wonderful vaccination progress, the actual case numbers in the US have increased 20% in the last 14 days.  The daily case count has risen to over 62,000. Thousands of cases caused by foreign and domestic variants have been identified. The U.K. variant has been identified in over 11,500 cases, even with limited genomic testing availability. Michigan has seen its hospitalizations double in the last couple of weeks. The US death rate is not going down as we continue to lose nearly 1,000 Americans a day. The COVID-19 American death toll is over 552,000. Our European allies are experiencing drastic increasing numbers causing countries like France to implement its third national lockdown. Throughout this pandemic it has been noted that Europe is the harbinger of things to come in the US, 3-4 weeks later. Many of our infectious diseases’ experts are pleading that we be more vigilant so as not to continue that trend of following Europe. They lament that we are on the brink of another surge. We can prevent this if we are smart and just continue to WEAR masks, WASH our hands, WATCH our distance, and get vaccinated when our time comes. 

We are continuing to see some state governments function in an anti-science political mode as they eliminate mask mandates and some even eliminating ALL COVID-19 restrictions. Others, like Ohio, are slowly relaxing restrictions while accelerating vaccinations and even offering the one-shot J&J vaccine to college students before they go home ending the school year.  Some private businesses are also disregarding the experts’ recommendations that safeguard their customers. For instance, MLB Texas Rangers allowing 100% stadium capacity as opposed to 25-33% capacity in other stadia. The ill-conceived full capacity decision is contextualized by the postponement of the Mets vs Nationals game on opening day because of players testing positive. 

Our country will be best served by governments at all levels, businesses, organizations, and individual citizens being patient. As more of us are vaccinated, the spread of this deadly virus can be in our rearview mirror.

Vaccinations and Financial Help Has Arrived

The Biden-Harris Administration took control of the reigns of the federal government on January 20, 2021 with our country in the throws of a raging pandemic caused by the virus, SARS-CoV-2. The resultant USA COVID-19 disease has occurred in over thirty million cases, killed over 542,000 Americans, and cost US approximately ten million jobs, over the last 14 months.  Anybody objectively and realistically opting for improvement of our country’s physical, psychological, and economic health concludes that effectively fighting this virus is the master key.

A focused federal government directed, and supported program is now being implemented to provide reliable consistent information from our federal agencies such as the CDC, FDA, HHS, and others. The Defense Production Act (DPA) has been used to improve testing, PPE (Personal Protective Equipment), as well as vaccine production. The Covid testing of our K-12 students will be boosted by $10B made available in the recently passed $1.9T American Rescue Plan. Knowing that the production and administration of safe and effective vaccines are the lynchpins of controlling this disease, this administration has reached its initial goal of 100 million shots in arms in the first 100 days was met 42 days early. The new goal set is 200 million shots in arms in the first 100 days. There are plans for 25 million vaccinations to be performed this week alone. The three vaccines that are available for use in the United States, Pfizer, Moderna, and Johnson & Johnson, are getting widespread use and are proving their worth.  The vaccine produced by AstraZeneca has reportedly been shown to provide 76% effectiveness against Covid-19 symptomatic illness. This vaccine is less expensive to produce and does not have severe freezer requirements.  Emergency Use Authorization is likely to be requested by the end of April. The good news is that the vaccine needs of the USA over the next 3 months will likely be achieved by the currently authorized vaccines. 

Although US vaccinations are more widespread, there still exist discernible and measurable discrepancies in vaccination coverage in most states. Like the disproportionate impact of Covid-19 on racial/ethnic minorities the vaccinations have also been less likely to penetrate the socially disadvantaged communities. The outreach efforts by a variety of governmental and non-governmental organizations (NGOs) are being particularly focused. The Hamilton County health officials are setting aside 20% of its vaccines for pop-up clinics in suburban areas of greatest disparities. Only 7.21% of the Black population of Hamilton County has been vaccinated while 25% of the residents of the top 5 vaccinated zip codes have received their shot (only 7% of those are black). 

Getting our kids back in school provides psychological and financial relief for parents.  A recent change in CDC guidelines allows students to be 3 ft apart as opposed to 6 feet. Additionally, the American Rescue Plan provides $130B for schools. The Biden policies in place have resulted in slightly less than half of K-8 students being back in school, full time. The President’s articulated goal is over 50% in the first hundred days. 

Just as Covid-19 physical illness can have a devastating emotional effect on its victims, the loss of jobs and businesses has also resulted in considerable despair. Thus, addressing the economic impact of this pandemic is essential. The American Rescue Plan is putting $1400 in the pockets of 80% of Americans. Over 100 million Americans have already received this benefit. This real economic relief will improve the psychological health of recipients. 

We are not out of the Covid woods yet! Variants continue to increase as states are relaxing restrictions.  Spring breakers are partying, maskless, and are due to return home from the warm beach climates. The concern is that they will carry the more contagious and deadly variants with them. Our CDC director, Dr. Rochelle Walensky, is literally begging us to follow mitigation because new cases are still hovering at slightly above the 50K per day level. WEAR your mask, WASH your hands, WATCH your distance, WAIT your turn for your vaccine. If you have been fully vaccinated you can get together with another household, also fully vaccinated, without masks or social distancing.

COVID-19…The Bad, the Good, and the Be Patient!

There is good news and there is bad news!  The bad news is that our country has lost 525,000 citizens since this SARS-CoV-2 virus came to our shores a little over a year ago.  The seven-day average of American deaths remains just below 2,000 per day. The number of newly diagnosed cases in the US has plateaued at around 59,000 a day over the last 7 days.  This level of daily cases is truly untenable. We know the hazards of this level of ongoing community spread because of the history of the US surges which we have seen over the last year. The early June 2020 daily case number plateau of 20,000 was followed by a 66,000 daily case 7-day average in late July 2020. That surge abated to a level of a September 2020 plateau of 45,000, only to be followed by the January surge to a horrendous 250,000 daily 7-day average. Now we have come down to a 59,000 daily case plateau. The question and concern are whether we suffer another surge, as they have in Europe, because of the variants and our unwise abandoning of proven mitigation.  The U.K. variant (B.1.1.7) now represents 3,133 cases in the USA, up from 2,753 cases three days previously. The known cases of this variant are rising in Ohio. Additionally, we have now identified the first Brazilian (P.1) variant in Ohio, as well as two additional “home grown Ohio” variants. Fueling the possible future surge in cases are the college students travelling to the beaches for spring breaks and multiple states, including Texas, completely lifting mask mandates. These are dangerous behaviors that can lead to more hospitalizations and deaths.  It is foolhardy to throw away hard-fought gains, especially when we are closer to winning the battle against COVID-19.

The good news is that we have the tools to take a different course and help save ourselves.  We can get vaccinated as soon as our time comes. Americans are rolling up their sleeves as demonstrated by the 2.9M people vaccinated on this past Saturday, March 6, and 2.4M vaccinated yesterday. Approximately 9.4% of the US population has been fully vaccinated. The ‘fully vaccinated’ designation is given to an individual two weeks after the 2nd dose of either the Pfizer or Moderna vaccine, or two weeks after the one-dose Johnson & Johnson vaccine. We now have more Americans fully vaccinated than the number of known COVID-19 cases in the country. The disconcerting news on the vaccination front is that disparity in vaccine administration remains. Medically underserved communities and communities of color are receiving a disproportionately low share of shots in the arms. The data collected confirms this even though only 53% of the states are reporting vaccination data by race and ethnicity. This Administration says that “equity is mission critical” since we cannot get out of this pandemic when those who are affected most are not given appropriate vaccination opportunity. The White House has a three-prong approach and a Health Equity Taskforce to achieve this end, being led by Dr. Marcella Nunez-Smith. We healthcare providers will be watching closely for the needed results of these efforts because we ALL deserve protection.  

The benefits of having been vaccinated are realized not only in the individual emotional relief in having had the shot(s) but also in the CDC guidance just released today which allows the following:  

1)People in a household who have been fully vaccinated can get together with another fully vaccinated household indoors, without masks and without socially distancing.

2)Fully vaccinated people in a household can get together indoors with an unvaccinated household consisting of individuals not at risk for developing severe disease (CDC website) without masks and socially distancing. 

3) Fully vaccinated individuals, who are not symptomatic, are no longer advised to quarantine after being in contact with a COVID positive individual. 

Other than the circumstances above, everyone is encouraged to WEAR your mask, WASH your hands, WATCH your distance, avoid crowds, and WAIT for your turn to get vaccinated. Today’s changes in CDC guidance should be motivation for getting vaccinated. Our adherence to recommended mitigation measures will bear more fruit as our patience persists for just a few more months.

We have a THIRD COVID-19 vaccine but is our improvement stalling?

Today, February 28, 2021, the Johnson & Johnson COVID-19 vaccine has been given Emergency Use Authorization for Americans, 18 and over. This vaccine employs a previously used technology consisting of a genetically engineered model of a portion of the virus protein transported on an inactive, commonly occurring, virus (adenovirus).  Let us be clear that there is no live virus used and no chance that anyone who takes the vaccine can contract a disease from the vaccine. This J&J vaccine was tested on 44,000 people in the USA, South Africa, and Latin America. The US testing has found this vaccination to be 72% effective in preventing clinically apparent disease, 85% effective in preventing severe disease and 100% effective in preventing hospitalization and death. A huge advantage that this vaccination has over the Moderna and the Pfizer mRNA vaccines is that it only requires regular refrigeration for storage and not the freezer or super freezer storage, respectively, of the other two. The other advantage is that the J&J vaccine is only ONE shot as opposed to the other two requiring two injections, 4 or 3 weeks apart. There are four million doses of the J&J ready for immediate shipping and 20 million doses expected by the end of March.  The company has contracted to deliver US 100 million doses by the end of June. 

The progress made against COVID-19 is on somewhat shaky ground even though since the January 11 peak the seven-day case average has dropped 74% and hospital admissions have decreased 60% since their peak in January. The recently experienced steady decline in the new daily cases have leveled out at about 65,000 for the last five consecutive days, and still above the peak averages of the summer surge of 2020.  The global death count is 2.53 million.  Our country continues to bear a disproportionate 20% share of the world’s deaths although we have only 4.5% of the world’s population. 

The pace at which Americans are getting vaccinated against COVID-19 continues to improve.  The Biden administration committed to 100 million vaccinations in their first 100 days. A recognition of 50 million shots in arms at the first 37 days was just completed. Total injections since December 2020 is 72 million or 14.6% of the US population. The focus on older Americans has resulted in a dramatic drop in nursing home cases and 50% of the citizens over the age of 65 have been vaccinated, versus 8% four weeks ago. Specific attention in being paid to eliminating the early disparities seen and anticipated in vaccine administration by federal distribution centers and mobile units being stood up in underserved communities.  These efforts are being further aided by the utilization of local pharmacies, community medical centers and hospitals, and even door to door injections. Pulling out all stops to get Americans vaccinated is extremely important because we must get 75-80% of Americans vaccinated to reach population immunity sufficient to lessen spread. The benefits of vaccinations have been based on clinical trials until now, but a recent study out of Israel gives clinical confirmation. The study out of Israel on nearly 600,000 people, who had been given the Pfizer vaccine, was recently published in the New England Journal of Medicine.  Those who were 2-dose vaccinated were 94% less likely to become ill, 87% less likely to be hospitalized, and 72% less likely to die than people under study who were not vaccinated. 

The importance of picking up the pace with vaccinations is necessary to lessen the chance of mutations becoming problematic. Recall that the virus can not mutate unless it proliferates. The United Kingdom variant (B.1.1.7) was discovered here in Hamilton county on February 22 and is presumed to be in every Ohio county. State authorities are projecting that It will be the dominant strain in Ohio by late March to early April. There are ten variants identified as US origin. Of these, the New York (B.1.526) and the California (B.1.427) are of the greatest concern. We will slow the variants by continuing to mask up, even after vaccination; WASH your hands, WATCH your distance, avoid large crowds, and WAIT for your safe and effective vaccine!

Are We in The EYE of the COVID-19 Storm?

Covid-19 cases, hospitalizations, and deaths, all continue to fall.  Yet the US has just crossed the tragic threshold of 495,000 deaths. New daily cases have dropped to under 85,000 as compared to the peak 250,000 daily cases in mid-January 2021. These diminishing case numbers, which represent the fastest rate of decline since the beginning of the pandemic, have come about because of several reasons. First, there may be as many as 100M Americans who have been infected by the SARS-CoV-2 with only 29 million clinically diagnosed. Remember that there is an extremely high percentage of asymptomatic spread as well as a plethora of undiagnosed cases due to our testing inefficiencies. Even though it is not known how long already infected individual’s natural immunity will last, they do have some protection and they are not susceptible to infection during that time. Yet, they all should still be vaccinated.  Secondly, the positive effect of widespread vaccination is starting to be realized. Approximately 60M Americans have received at least one dose of either the Moderna or the Pfizer vaccine. Before this week’s winter storms, we had reached 1.9M injections per day.  The vaccination campaign will need to redouble its efforts to get back on track. Another factor for the decreasing numbers is “declining seasonality”, i.e., winter virus season is ending. Lastly, the positive results of most people WEARing masks, WASHing hands, WATCHing distances, and avoiding large CROWDS is being realized. While some experts project that there will be another surge over the next 14 weeks, others says that we will reach “herd immunity” by the end of April.  

By way of update, there is a new report on 2020 life expectancy data up until July 1, 2020. It shows that, due to COVID-19, life expectancy in the USA decreased by one year to age 77.8 years.  The life expectancy for Black folks decreased by 2.7 years. That means that life expectancy for Blacks is now SIX (6) years shorter than our fellow White Americans. The gap was closing but no more! Latino life expectancy decreased by nearly two years.  Note that this data is only for the first six months of last year. Further update based on the entire year of is likely to be worse. 

The cautionary news is that superimposed on a baseline level of cases higher than last summer’s surge, we will experience the foreign and home-grown variants. Currently, the UK variant (B.1.1.7) has been identified in 42 states. It is 40-70% more contagious and recent studies show it to be more lethal that the original strain of the SARS-CoV-2 virus. Less than 1500 cases caused by this variant have been identified in the US. Nevertheless, it is predicted to be the dominant strain by the end of March. Unfortunately, the USA does not perform adequate genomic testing which is necessary to identify viral mutations.  Only 0.4% of our testing facilities have the capability of the specific testing necessary. A corollary is that 43% of the genomic testing performed in the world is done in the United Kingdom.  A bit of good news is that both the Moderna and the Pfizer vaccines appear to be effective against this variant, as do the J&J and AstraZeneca. 

The other foreign variants are the South African (B.1.351), which has been identified in seven (7) states, and the Brazilian (P.1) which has been found in only two US states. Although the Pfizer and Moderna have been found to be effective against the South African strain, the use of the AstraZeneca vaccine in South Africa has been suspended due to a lack of efficacy.  The J&J vaccine is scheduled for Emergency Use Authorization hearing on February 26. Unfortunately, a manufacturing glitch will prevent the planned availability of 12M doses available at the time of EUA, and the contracted 100 million doses will reportedly not be available until June 2021.

Because of the world record proliferation of the virus in the US during December and January we now have ten variants of our own. The good news is that the pharmaceutical companies are confident that future vaccines can be adjusted to meet the challenge.

Turning the COVID-19 corner?... Mutant Variants Loom

Our country continues in the grips of COVID-19. The number of daily cases has fallen to below 100,000 for the first time since early November 2020. Even this current level remains much higher that the surge that we experienced during the Summer of 2020. US cases, hospitalizations, and finally deaths are all falling. Yet, we have reached over 27 million cases and 468,000 deaths.  We know that the devastating surge from which we are now improving was fueled by family and friend gatherings of late 2020. We can only hope that Superbowl LV Sunday gatherings do not reignite the fire as a superspreader event. 

We are getting much better news regarding vaccine availability and distribution.  Nearly 63 million of the Moderna and Pfizer vaccines have been distributed in the US.  Shots in arms are 43 million Americans so far, representing 69% of available vaccines having been administered. Vaccinations have increased to 1.3 million per week with a goal of 1.5 million per week. The NFL has offered its 32 stadia as mass vaccination sites along with various other large facilities around the country.  Several large retail pharmacies (Walmart, Walgreens, CVS, Kroger, Publix) will be able to provide vaccinations soon. The Biden-Harris administration is implementing an all-government approach to fighting this scourge by more extensive use of the Defense Production Act to secure and fortify supply chains for PPE, testing, and vaccine production. Additionally, 1200 active-duty soldiers are to be deployed around the country to assist in achieving vaccination goals. In addition to improved distribution, the supply of useable vaccines will increase when the Johnson & Johnson vaccine comes online.  The two major advantages of this vaccine over the other two which are authorized are that it is just one injection and it only requires refrigerator storage. Our government has purchased 300 million doses. The Emergency Use Authorization that has been requested will be heard beginning on February 26, 2021. Further supply augmentation will come, probably in the Spring, when the Novavax vaccine is made available.  Lastly on the vaccine front is AstraZeneca. This vaccine is the only one that has been proven by trials to lessen the spread of the SARS-Cov-2 virus (67% reduction in transmission), whereas all of them are effective at preventing illness. It should be noted that the AstraZeneca vaccine has been found to be ineffective against the South African variant.

The greatest threat to derailing our country’s journey back from a raging pandemic to more normal activities is rapidly proliferating mutations. Projections from Washington University (IHME) reveal that our daily case rates will continue to steadily decrease at least until June 1, 2021 unless the mutant strains proliferate significantly.  One of our continuing problems is that we do not have enough widespread genomic testing capacity for determining the presence of mutations. The three mutant strains from foreign countries, (United Kingdom, Brazil, and South Africa), continue to spread across the USA. The UK variant (B.1.1.7) is in 32 states. Nevertheless, this strain which is projected to be 45% more contagious, composes about 2% of the total US cases. This is projected to be the dominant strain in March. This spread can hopefully be stopped.  The best defenses against the original and the mutant strains are widespread vaccination and continuing to follow proper masking, hand washing, social distancing, and avoiding large crowds.  Viruses can only mutate if they proliferate. 

The CDC recently issued new mask guidelines found at https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html. The bottom line of these includes wearing a mask that fits against the face snugly, but not two disposable surgical masks. Secondly, wearing a cloth mask over a disposable surgical procedure mask or a mask fitter form over a 2 -3 ply cloth mask are other options. If you wear a KN-95 or N-95, then no additional second mask is recommended. Our Tristate area is doing remarkably well with mask wearing according to a recent survey by Interact for Health. Greater Cincinnatians are wearing masks at a 90% rate while in indoor public places. Seventy percent of us wear masks outdoors, in public. Please keep it up, the light at the end of the tunnel is getting brighter!

Get your COVID-19 Vaccination to Slow Mutation

Approximately one year ago, January 21, 2020, the first case of COVID-19 was diagnosed in the United States.  There have been over 26 million known cases of this dreaded disease in our country since that day.  The death toll continues to rise with January 2021 being the deadliest month to date. Over 95,000 Americans have perished in the month of January, bringing the death toll from this virus to over 440,000 citizens.  We must remember that there is a grieving family behind each one of those deaths!

A bit of good news is that the surge in cases and hospitalizations that resulted from ill-advised holiday travel and gatherings has declined.  A second bit of hopeful news is that vaccines are getting into arms at a faster rate.  Approximately 50 million doses of the Pfizer and Moderna vaccines have been distributed to the states and approximately 60% have actually been administered. Additionally, vaccines by Johnson & Johnson, AstraZeneca, and Novavax are on the US horizon.  Additional positive news on the COVID-19 treatment front is that the monoclonal antibody injections appear to PREVENT the development of the disease if administered early enough.  The treatment was previously recognized as useful for high risk, COVID-19 test positive people who had been symptomatic for no more than 10 days.  The recent study shows illness can be prevented in high-risk people, with antibody treatment being started (without a positive test or symptoms) after they have been in close contact with someone who has the disease. In both scenarios “high risk” includes a person age 65 or older, or a person who is obese or has diabetes.  Anyone who meets either situation should discuss the option with their treating physician. 

People of color have born a disproportionate share of the health, educational, and economic impact of COVID-19 and vaccination frequency is seeing the same trend. Black people are 3.5 times more likely to be hospitalized and 2.5 times more likely to die compared to our white counterparts.   In those 16 states which report COVID data by race, the rate of vaccination is two to three times higher in Caucasians than in African Americans. The explanation for this ongoing disparate result is not only in systemic barriers to access, but also because of the understandable hesitancy based on historical medical mistreatment of Black folks. The latter is not easy to overcome, but African American healthcare providers are here to show you that we have eagerly taken our vaccinations, believe in the safety and effectiveness of the vaccines, and see vaccination as an opportunity to take better control of our destinies. 

The last piece of bad news which we will address at this time is that of viral mutation.  Viruses constantly change becoming a new strain, or model so to speak, as long as they are circulating at high levels.  They only mutate (change) during replication. There are three foreign strains of concern at this point. One is from Great Britain and is present in over 30 US states. There is a Brazilian strain which was found in a person who had travelled to Minnesota from Brazil. Lastly, there is a South African strain which has been found in South Carolina and Maryland in people who had not been to South Africa. This means that there is already undiagnosed presence of this strain in those communities. All three of these strains are projected to spread more quickly although the lethality potential is not clear.

Our way out of this pandemic is for all of us to do everything we can to lessen spread of the disease and limit proliferation and therefore mutation. The US will achieve adequate protection when 75-80% of Americans have been vaccinated. Over 31 million Americans have been vaccinated and there are no known deaths from the vaccines and very few serious side effects.  People are dying from COVID-19, not from vaccinations.  Until the virus is no longer a problem, we must WEAR masks, WASH hands, and WATCH our distances! Please take the vaccine when your time comes so we can all get back to family and friends, jobs, school, travel, and leisure activities more quickly.

New President (and VP) …New Fight Against COVID-19

On January 20, 2021 Joe Biden and Kamala Harris were sworn in as President and Vice President of the United States. They are being handed the reins of managing this raging virus of COVID-19. Ironically, their inauguration day is a year, to the day, from which the first case of this dreaded disease was discovered in our country. By Inauguration Day there were over 24.2 million Americans infected and 407,482 American souls lost (more than in WWII).  There were a record 4,131 Americans who died from this disease on that day alone. Covid hospitalizations receded slightly to a staggering 123,820.  In addition to the health consequences our economy continues to suffer demonstrated by 900,000 new jobless claims this past week. Tens of thousands of small businesses have shuttered, some permanently, since this virus came to our shores. Many of our children remain on virtual or blended school schedules. New strains of the virus, which are more contagious but not more deadly, have been discovered around the world.  They have been identified in at least twenty of our states, with two different strains having been found in Ohio. The good news is that the preliminary data from researchers reveals that the Pfizer vaccine remains effective against the United Kingdom mutated strain. More analyses are being conducted regarding the other vaccines and strains. 

Lastly on the news front is the slow administration of the vaccines before Inauguration Day. Approximately 54.1% of the distributed Pfizer and Moderna vaccines had been administered. Only 4.3 % (16.5 million) of the US population has been inoculated. To put this in perspective, the vaccination rate per 100 citizens is approximately seven times higher in Israel when compared to the US.

Early indications are that this new federal administration is intent upon approaching these pandemic induced challenges with eyes wide open and actions based on science and truth.  A national plan for which many Americans have been clamoring was released on January 21, 2021.  It can be found in its entirety online and is entitled “National Strategy for the COVID-19 Response and Pandemic Preparedness”. The plan is organized around seven goals: 

“1. Restore trust with the American people. 2. Mount a safe, effective, and comprehensive vaccination campaign. 3. Mitigate spread through expanding masking, testing, data, treatments, health care workforce, and clear public health standards. 4. Immediately expand emergency relief and exercise the Defense Production Act. 5. Safely reopen schools, businesses, and travel while protecting workers. 6. Protect those most at risk and advance equity, including across racial, ethnic, and rural/urban lines. 7. Restore U.S. leadership globally and build better preparedness for future threats.”

The President signed ten (10) Executive Orders (EO) on his first and second days in office to provide specifics for addressing these seven goals.  This Administration has vowed is to get 100 million Americans vaccinated within the first 100 days of its authority.  Specific measures to fulfill each one of these seven goals are contained within these EO’s as well as by the determination to be truthful, accept blame, and lead by example. One of the major pushes is mandating mask wearing on federal property and during interstate travel (planes, trains, and buses). That means “no mask, no fly”. Even the airlines are in favor of this federal mandate because it makes it easier to enforce their rules which were oftentimes the source of disregard and open conflict. Another example of EO use is that the Defense Production Act will be fully implemented to allow for better and more extensive testing, improving the supply chain for PPE and vaccines, and to ensure that vaccine production meets demand. 

Optimism is high regarding this new approach that will treat this effort against COVID-19 as the WAR that it is. Things will get worse before they get better as it is projected that 539,000 American lives will be lost to Covid-19 by April 1, 2021.  The success of this national plan is a partnership between the public, governments, business, and our overly stressed healthcare system. We must each still do our part.  WEAR a mask (even after being vaccinated), WASH your hands, WATCH your distance, and get vaccinated when your time arrives.

COVID-19 Storms the Capitol and the Country

A mob, mostly unmasked, stormed the United States Capitol Building on Wednesday, June 6, 2021.  This attempted coup and ongoing planned insurrection is occurring amid a raging pandemic.  Just as most group events planned or encouraged by this President go forth without masks or social distancing, this riot may become a superspreader event.  The devastation rained down on our country by COVID-19 is depicted by 377,616 deaths (more than 30,000 this year), 22.7 million cases, and hospitalizations hovering around 130,000 daily. There have been over 100,000 Americans per day in the hospital due to COVID-19 for the last 41 consecutive days.  We are beginning to see the result of the ill-advised Christmas and New Year’s travel. The depth of our despair from our fellow citizens’ decisions will not peak for another 2-3 weeks. Hospitals and ICUs across the country are already overwhelmed. 

On the news front the variant that has been growing exponentially in Great Britain is now identified in ten American states. Secondly, our federal government has distributed approximately 26 million vaccines, but less than 9 million Americans have been vaccinated. This extremely slow rollout is a continuation of the mismanagement of this pandemic. The lack of reliable information, testing, contact tracing, personal protection equipment (PPE), mask wearing policy, and a national coordination plan have resulted in the tragic loss of US lives, health, livelihoods, and educational advancement. To improve this abysmal 35% vaccine usage the Operation Warp Speed is scheduled to announce new guidelines today.  It is reported that a new policy will allow for the vaccination of anybody 65 years of age and over as well as any person with a preexisting condition which makes them more susceptible to COVID-19. These conditions include diabetes, chronic lung and heart disease, obesity, and immunocompromise.  The specific details of this new guideline are yet to be worked out. The general plan is that the government will no longer hold back the vaccines destined to be the second dose for people. It should be noted that the problem with the slow rollout is not a supply issue but the lack of processes to get shots in arms.  If vaccine demand increases, we will need to rely on manufacturing to catch up to the second dose necessity.  Everyone who gets a first dose will still require a second shot for adequate protection.

The spread of this horrible disease is being fueled by the family gatherings and travel around the recent holidays, as well as the recent political rally and the insurrection in Washington, D.C. (the latter two contesting the results of an already decided election). These activities were conducted by participants who traveled from, and then back to, all areas of our nation. It will take 3-4 weeks before we know the extent to which those perpetrators have spread of this virus around the country.  What has already become apparent is that our legislators were forced into situations that increased their chance of contracting COVID-19.  Domestic terrorists took over the Capitol spewing aerosol and droplets between them, assaulted and killed a law- enforcing officers, broke windows and doors, pillaged offices, desecrated the congressional chambers. Congresswomen and men were forced into hiding and/or sequestered in tight quarters fearing for their safety. Legislators in both parties hide away in conference rooms until the Capitol had been retaken.  Some lawmakers refused to wear the masks offered to them. The entire six-hour delay in conducting congressional business left the congress people stuck in an environment where this disease could spread. One House member’s positive test was revealed the night after the insurrection.  Three Democrat representatives, one a cancer survivor, who were in a “safe room” with those who selfishly refused to take the mask offered, have since tested positive. This incident alone shouts for mask wearing, which should not be ideologic because it is science. 

The virus of lies regarding an already decided election is on full display as the fuel for this attempted coup. A virus of lies also fuels the exponential spread of COVID-19. Truth is that we must WEAR masks, WASH hands, WATCH our distance and WAIT our turns and get vaccinated when available.

New Year…Same Virus

The year 2020 ended with December being the deadliest month, 77,572 lives lost, from the COVID-19 disease.  More people died in December than in October and November combined. The known US death toll from COVID-19 has reached 354 million, with one American dying every 33 seconds, currently. Hospitalizations reached a record 128,210 in our country on January 4th, with many ICU’s capacity being overwhelmed. Even when facilities expand treatment areas to hospital gift shops, hallways, and conference rooms, the ability to stretch weary healthcare providers does reach a limit.  Field hospitals have been reopened in California, Texas, and other areas. Officials in Los Angeles are requesting that the USN Mercy hospital ship be redeployed to their area. Worse news is that these numbers are likely to get worse over the next 3-4 weeks because of holiday family gatherings and travelers disregarding the CDC advice to holiday with those with whom you live. A pandemic record of 1.3 million airport travelers were screened on Sunday, January 3rd, culminating Christmas and New Year air travel of just over 7 million passengers. The healthy and young may not get sick but the people to whom they bring this virus are more likely to become unwitting victims. 

On the news front, a viral mutation has increased the spread of COVID-19 in the United Kingdom (UK). The government decided yesterday to implement a restrictive lockdown until mid-February.  This mutation of the original virus has been identified in four states in the USA.  Though not more deadly, this new strain seems to spread more easily and affects more people under the age of 55.  Information available so far indicates that the currently available vaccines, and those in the pipeline, will still be effective against this new variant of the SARS-Cov-2 virus. The presence of this mutation magnifies the need to decrease the spread of the virus by every means possible, including an effective vaccination program. Lastly in the news, the AstraZeneca vaccine has been approved for use in the UK. It has the advantages of being less costly and storage requires only a regular refrigerator, as compared to the Pfizer and Moderna vaccines currently available in the USA. 

These numbers regarding infections, hospitalizations, deaths, and mutations make the slow rollout of the vaccine in the US even more alarming. The current federal administration projected that there would be 20 million Americans vaccinated by New Year’s Day 2021.  That date passed with roughly 15 million vaccine doses having been distributed and only 4.5 million Americans vaccinated. We have vaccinated 1.4% of our population compared to Israel having vaccinated about 14% of its people. Indeed, it is a monumental task to rollout an effective and efficient vaccination program particularly considering subzero storage requirements, holidays, and vaccine hesitancy. Yet ALL of these barriers were known and clearly predictable while the daunted Warp Speed was successfully overseeing the development and production of the vaccines.  The White House decision to leave the “last mile” (i.e., shots in arms) as the responsibility of resource-strapped states is doomed to the same insufficient result that we have experienced from Washington abdicating responsibility for PPE, testing, and contact tracing.  The federal government had enough time to provide a plan and resources so that states could use current large facilities and train personnel for vaccine administration.  The current military and retired medical and military personnel (adequately vaccinated and PPE protected) could be used to help staff the program. This would free up more frontline current providers to take care of the current ill. The Defense Production Act still needs to be fully implemented to address supply chain issues.  

Ohio has vaccinated 1.36% of our population, so there is clearly much work to be done.  The Ohio vaccination plan is outlined at: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program

It is said that vaccines don’t save lives, VACCINATIONS do. Government has failed us thus far and lives will continue to be lost unless this changes.  In the meantime, we as citizens must be consistent, patient, and tireless.  WEAR masks, WASH hands, WATCH your distances from people with whom you do not live, and WAIT for your vaccination turn and please take full advantage of the opportunity!