I’m starting to see some patients who have been vaccinated. I think it’s great that people are getting vaccinated though I know the roll out is super slow. We’ve also seen a number of people test positive after one vaccine dose. This is a little disappointing and argues against giving only one dose of the vaccine to spread it out to others. I’m aware of a couple of cases of people who were fully vaccinated and got tested because of exposure to a family member who was positive and then tested positive themselves. We knew this could happen, but I was hoping it wouldn’t. In the cases I’ve heard about, the patients were asymptomatic but had close contact with family members (spouse/kids), so perhaps that close contact increased the viral load they were exposed to. I also know of a vaccinated person who had a house full of COVID family members and remained negative, which is the purpose of the vaccine. Over and over this week, I saw data that a COVID related death is highly unlikely 2 weeks after full vaccination.
The COVID peak appears a little more in the rear-view mirror (for now) as we continue to see a flattening of the number of times we order our COVID isolation protocol and the number of admissions. We’re now 5 weeks since our second peak, down about 35% in the number of patients we keep on COVID isolation in the ER. We have to go back to about November 10th to see numbers like this. Our admission rate for this group of patients remains high at about 40% which is the general ballpark it’s been since November. We’ve also seen a flattening of the number of patients hospitalized with COVID and the number of positive cases we diagnose each week. In the ER, looking at new cases, we’re about half the total numbers of where we were a month ago. Our percent positive rate among symptomatic patients is down, which is good. Our overall percent positive rate is flat the last few weeks but down from December. We’re busier with COVID than the summer and about at the mid-November numbers. I worked last evening and was busy with a lot of sick people, but only a few had COVID.
A study came out this week showing that most people who had COVID had antibody protection for at least 6 months. Since the majority of cases in America have occurred in the last 6 months, there is a good chunk of Americans who are protected between native disease or now with vaccination. That’s great. What is unclear and concerning is whether those who had the original COVID can get infected with one of the variants. What I’ve read is that people in South Africa did get infected by the two variants so that is concerning. The South African variant is here, and our efforts should still be in the containment phase and reducing spread with masks and distancing. Earlier this week, I had a socially distanced lunch protected by large plastic partitions with a couple members of our ICU team. Although the ER looks better, they reminded that they still have patients younger than me who have been on the ventilator for a long time and get new admissions every day. They still have people dying from COVID. And they also told me stories of their own family members who still think COVID is overblown or a hoax. We had a similar discussion among some ER staff. It’s amazing to me that with 450,000 American’s dead, and with COVID being the main story line for most of the world, how can anyone think it’s overblown or a hoax? And it’s honestly so frustrating and exhausting for healthcare workers to hear it from people who they can have an honest discussion with. Although the numbers around the state and the country show the same kind of improvements we’re seeing in the ER, COVID is not gone. I continue to get calls, texts, DM’s from friends who I know from the neighborhood, kids stuff, etc…who test positive and have questions. Fortunately, most have had mild to moderate symptoms, but across healthcare, we continue to see young adults with complications and a rise in pediatric admissions, so I don’t think it’s fair to completely disregard it and say to yourself or your family that COVID is better or you’ll be fine if/when you get it. I would not go to any sort of Super Bowl gathering this Sunday.
There is more great news with the data from the Johnson and Johnson vaccine as they have applied for an emergency use authorization. This possibly means more available vaccine in about 2 weeks. The J&J vaccine uses an inactivated human cold virus to get the genetic material of the spike protein into our bodies to trigger our immune system. It’s different technology than the mRNA used in the Pfizer and Moderna vaccines, which I know was a concern for some people. The FDA had set a goal of 50% effective for vaccines. We got spoiled with the success of Pfizer and Moderna, but let’s not discount the J&J vaccine. It doesn’t require the deep freeze (so easy to transport), is single dose (so easy to administer), and has about a 66% effectiveness rate, so it will reduce transmission. (In the US, the effectiveness was 72%, twenty-eight days after a single dose and there was decent effectiveness in South Africa against the SA variant). Perhaps more importantly, it greatly eliminates severe disease, defined as requiring hospitalization or death. Although it’s unclear to me if it prevents some of the long-term complications that can occur with COVID, reducing hospitalizations, death, and the spread of disease is huge. It will be more vaccine available to go into Americans. It will be vaccine that will help eradicate COVID from the rest of the world. Getting world-wide reduction in cases is critical to prevent further mutations from occurring. And studies are taking place now to see if a second dose improves its effectiveness. I’m coming to grips with the chances that we’ll all need a booster dose later this year to account for the variants, so I’m still all in favor of getting the first available vaccine so that as a society, we can reduce spread of the virus.
Kids sports are important in my household and they may be important to you as well. My son has been playing club soccer. The fall almost felt normal with games and practices. I pulled him out from December until about a week ago because I felt the numbers of cases were too high. I’m relieved that cases are declining and could let him go back. The National Federation of State High School Associations (NFHS) announced this week a revision to its guidelines on youth sports. Transmission risk in sports is multifactorial but appears most related to the community infection rates. Other key points identified include: non-contact sports have lower infection rates than contact, outdoor sports have lower infection rates than indoors, and facemask use indoors makes in comparable to outdoor risk. Most teams that dealt with COVID, didn’t get it from spread on the field, but rather from the pre- and post-game/practice social time when athletes tend to be close together and hanging out (that was the biggest impetus for me to have my son take a break). As we continue to look for normalcy in our life, I hope we can find some safe ways to get kids back on the field. And for what it’s worth, my decision to let my kid play is based on the whole picture of the kid, the sport, and me as a parent, not necessarily as an ER doctor.
Science matters. Wear a mask. Practice physical distancing.