Dr. Mike discusses increasing presence of COVID-19, herd immunity and preparation in the ER for distribution of vaccine when available.
The virus did not magically disappear this week. The nation hit the 100,000 new case mark for a single day a couple of times this week. Maryland had 1000 cases reported in one day. They also reported 10 deaths that same day. Keeping in mind that deaths reflect patients who were typically infected 2-4 weeks ago when daily numbers were a bit lower, I do think it helps to show the current mortality rate of COVID at about 1%. Earlier in the pandemic it was much higher. I don’t think there’s evidence that the virus is weakening so this is likely related to better treatment, younger patients, and less crowded hospitals.
Eli Lilly stopped their antibody trial in hospitalized patients recently after the NIH showed the medication had no benefit in that patient group. This antibody cocktail is similar but not the exact same therapeutic as what the President received. Additionally, I’ve heard discussion that the convalescent plasma we’ve been using in hospitalized patients may not be helping and that some hospitals are considering not giving it to patients. However, published this week in the NEJM, the Eli Lilly convalescent plasma derived virus neutralizing monoclonal antibody treatment, was found to lower the severity of symptoms of outpatients in a phase 2 trial. So perhaps, early identification and treatment for outpatients will be coming down the line for antibody therapy and/or convalescent plasma.
A couple of other things to keep in mind. There was a recent publication suggesting that a mutation in the virus makes it more transmissible and results in a higher viral load. In the same study, they report that there were no additional bad outcomes as a result of the high viral load but in another study, “when COVID-19 patients are admitted to the hospital with pneumonia, their risk of intubation or death can be estimated based on their viral load.” Patients with higher viral loads did worse.
I still think the best plan is to try to avoid getting it. So, let’s talk about herd immunity. I’ve written about this a couple of times, so I’ll keep it brief. Herd immunity counts on so much of the population having antibodies that the virus has limited options of people to infect and ultimately dies out. Herd immunity is great when we have a vaccine. When was the last time you heard of anyone you know getting polio? But if we’re counting on the virus going through the country and infecting the 70% of people that are estimated for herd immunity to occur, then we’re talking about 230 Million people getting COVID. With a mortality rate of 1%, that’s about 2.3 Million deaths from COVID. And that’s before we factor in anyone who will get reinfected since it’s unclear how long antibodies will last and be protective. Waiting on herd immunity does not seem like the right plan at this time.
So that brings me to the vaccine and a little more from my world at VHC. We had another vaccine distribution planning meeting this week. Although we don’t know when we’re getting the vaccine or how many dosages we’ll get, we are making plans to store and distribute it. It’s interesting since we don’t know who will be first in line to get it—healthcare workers, only those with risk factors, community members with risk factors? But we did get a new 26 cubic foot freezer (about the size of a large household refrigerator) that goes to -80 C (way colder than your typical household fridge). Remember, part of the challenge with one of the vaccine candidates is it requires very cold storage, which makes distribution through pharmacies and doctor’s offices challenging. Our new freezer can store thousands of doses though we’re not sure if we’re starting with 500 or 1000 or more (probably not). Surveys show that about 2/3 of healthcare workers (HCW) are receptive to receiving the vaccine. We have thousands of people working at VHC. We have hundreds and hundreds of people who are frontline docs, nurses, techs, aides, etc…working in areas that routinely treat COVID patients. I do think that first batch we receive will go very fast, which is part of the reason we have people prioritizing deployment. When it comes to a HCW thinking through their own decision to take the vaccine if offered, many will likely base it on their own risk profile as well as how much they interact with COVID patients. Some is also based on how much they trust the vaccine for safety and efficacy. I think early on, each of us will probably look at the research to see how beneficial the vaccine is, what the side effect profile is like, and we’ll also talk to our local experts to get their take on the research. Having antibodies to COVID or getting the vaccine will not allow us to run around without masks and PPE so we’ll still have to careful at work and around high risk patients.
Personally, I’ve been called or texted by several good friends this week whose high school or college age kids have been exposed or diagnosed with COVID. I got a text from a college student at a local university about the bump in cases he’s dealing with and how a sports team was quarantined. It’s definitely out in our neighborhoods. And when it’s among the kids, it finds its way to the adults. Last week I reported a noticeable increase from previous weeks in positive COVID cases, higher positivity rate, and overall volume. This week held steady. Not another stepwise increase which is nice but also not a retreat to the levels seen the previous month. I had a couple of shifts earlier this week where COVID patients ran the gamut of critically ill to testing people who were exposed. The ICU had some good saves but ICU docs I talk to around the area tell me they still have patients dying of COVID pneumonia. COVID is still here. It’s getting worse around the country. A vaccine might be close but it’s not here yet.
Science matters. Wear a mask. Practice physical distancing.