This was a really good week when we look at our ER test data. We have had a significant drop in our percent positive rate for both our symptomatic patients and all-comers in the emergency department. The overall ER positivity rate in early January was about 23%. Now it’s <8%. The general goal for the state is <5% and considering we have a sicker population, our rate is pretty good. These rates are in the same ballpark as late summer and early fall. The absolute numbers of new cases that we’re diagnosing is also back to the September range for both symptomatic patients and all-comers. We have about 25 to 30% of the number of COVID patients that were diagnosed in the emergency department this past week compared to December and early January. The hospital census has been holding steady for the last several weeks and even earlier this week, I didn’t expect to report any real decline. However, as of this morning, we’re down a solid 10-15% from where we’ve been over the past several weeks, and the hospital census is down about a 35-40% compared to our peak earlier this year. My best guess as to what is accounting for the drop in new cases is that there has not been a lot of family get togethers since the holidays, as people hunker down this time of year. If there were a lot of Super Bowl parties in the area, my guess is we will see a bump in cases over the next couple of weeks.
Although our acuity (how sick people are) is still high in the ER, a colleague at VHC told me he didn’t see any COVID patients during his shift Wednesday evening. That’s pretty unusual over the last 10 months. We also had a day this week where none of our “symptomatic” patients tested positive though we did have several other positives from our screening process. I went into my shift last evening wondering if I would also see no COVID patients. No such luck. I did have 2 COVID patients, and then another couple that were kept on COVID precautions because of their risk factors. But much like last May, the feeling that the COVID surge has passed is palpable, and that’s a welcome relief for everyone working in the ER.
The next surge is expected to be in March as the new variants become more common in the area. The variants from the UK and South Africa are known to be up to 50% more transmissible and if and when they become predominant in the area, we will again see a rise in new cases. Earlier this week, it was reported that the new variant from the UK is doubling in numbers every 10 days, which could make it the predominant strain causing disease by March. It’s the rapid transmission that would be the cause behind another surge next month. Public health officials do believe there is time to reduce the spread by using mitigation efforts such as masking and distancing. For now, we do believe that the vaccine should offer protection from hospitalization and death from the virus variant. But since such a low percentage of Americans have received the vaccine, there are likely to still be large amounts of vulnerable Americans.
Research with old medications continues as well. There was some early positive data with colchicine, a gout medicine, that is undergoing peer review before it’s recommended for routine use. The Recovery Trial is a large, multi-center trial out of the UK, which has produced some great data throughout the pandemic. Key findings from this group so far showed that hydroxychloroquine, among many medications wasn’t beneficial but that dexamethasone was, which turned out to be a game changer. This week they released data looking at Roche’s arthritis drug Actemra (tocilizumab), which when used in the critically ill patients, resulted in reducing ventilator needs and patients were 14% less likely to die within 28 days of onset of disease. It looks like one life is saved for every 25 patients treated. This is potentially very good news but we’re now waiting for more data and further recommendations from specialty societies.
The CDC had two really big press releases this week. The first one has to do with no longer needing to quarantine after a COVID exposure if it’s 2 weeks after your second vaccine dose, and you’re not symptomatic. This is good news for keeping people working and shows confidence in the vaccine that you’re unlikely to contract COVID after exposure. There are a few caveats, including the type of contact and duration of exposure. While the CDC didn’t comment on healthcare workers, we certainly hope this will keep healthcare workers on the job, rather than quarantining after unanticipated exposure. It really does seem to say that you’re unlikely to be an asymptomatic carrier if you’ve been vaccinated but the CDC did not come out and say that. The other news from the CDC is a reinforcement on the benefits of double masking. The masking messaging has been pretty screwed up since the beginning of the pandemic on many levels, but research is showing that a cloth mask over a blue surgical mask can reduce spread of particles by 92.5%. Wearing a mask protects you, but also protects others from you. It really is bizarre to me how there can be people that don’t wear masks when in public and close to others.
One of the questions I keep asking myself is why can’t Pfizer make more vaccine faster. I dug around in the Pharma news and there was actually some news this week about how Pfizer will speed up production of a batch from 110 days to 60 days. I never would have thought it would take that long but I’m an ER doc and not a drug manufacturer. Here’s some details from the article: “Pfizer and BioNTech’s manufacturing network depends on six facilities split between Europe and the U.S. Stateside, the vaccine starts its life at Pfizer’s Chesterfield, Missouri, plant, where the DNA is produced. It then heads to the company’s facility in Andover, Massachusetts, for transcription into mRNA, before finally making its way to Kalamazoo, Michigan for fill-finish—with lipid and lipid nanoparticle production and formulation taking place somewhere prior to that final step. I still can’t find how many doses are in a batch but cutting the production process almost in half should definitely increase supply. {As an aside, I spent a couple of years after college as a pharmaceutical rep for The Upjohn Company, which later sold to Pfizer. I spent a month for training in Kalamazoo at the headquarters and toured their manufacturing plant.}
Science matters. Wear a mask. Practice physical distancing.
Mike