Although the more contagious and perhaps more serious variants are on the rise across the country, that hasn’t impacted my view from the ER. Our hospital inpatient census is down a bit compared to last week. Interestingly enough, it was down even further a few days ago to a level that was really exciting to me, but since I use the Friday morning number for this post each week to remain consistent, I can only say it’s down a bit from last week. The percent positive rate for all the tests we do at the hospital continues to decline as well. The majority of these tests are done on non-COVID patients that are here to have surgery, outpatient procedures, and deliver babies. This percent positive rate has been a pretty good indicator as to what’s going on in the local community, and each week seems a touch better. On the ER side, the number of patients requiring COVID isolation is the lowest it’s been in a long time. That’s great news since it represents potential COVID patients with symptoms as well as those who are known to be positive. On the other hand, our total numbers of COVID patients that we diagnose is not declining. They’re not increasing either but rather holding steady within a handful of total positive cases of each other week after week. This is similar to what is being seen around the country as daily positive new cases seems to have leveled off, after a steady decline since January. We’re clearly seeing much less COVID than we did in early January, but it’s not gone. And I do believe it’s a race to vaccinate before the variants cause an increase in cases (more on the UK experience in a bit).
The AstraZeneca vaccine has been in the news a lot this past week. As you may know, this vaccine has been used in Europe but was put on hold recently by many European countries due to concerns about blood clots. Here’s the deal. There were about 40 blood clots in the 17 million patients who received the vaccine. As you look at the numbers, we expect 1-2 blood clots (DVT,PE) for every 1000 people. We also see blood clots with COVID patients, so if you look at 17 million people, some of them will get blood clots. The only piece of this that is perhaps a touch concerning is that of those 40, a very small number were associated with very atypical blood clots. That is not enough to not use the AstraZeneca vaccine and while the headlines may read that blood clots cannot be ruled out as being linked to the vaccine, ultimately Europe’s medical regulator concluded that the vaccine is safe and effective and the vaccine is being used again in countries that paused it. The AstraZeneca vaccine has not gone to the FDA yet for approval but is expected to reach them soon. Getting it approved and in use in America and throughout the world will be another tool to help combat this disease.
The AstraZeneca vaccine was co-developed with Oxford and was the first vaccine to hit my radar last year. It’s been used extensively in England. Despite the UK having a higher percentage of the variant than the US, they’ve seen a 90% decline in the daily number of new COVID cases since January. The US has only seen a 79% decline. One difference that may account for this is the strategy the UK has gone with regarding vaccine. They actually went after the elderly first, not the health care providers, but more significantly, made the decision to get more people their first dose and delay second dosages whereas the US rollout was focused on complete vaccination (which I have supported from day 1 of the vaccine rollout since we didn’t have data showing the effectiveness of partial vaccination). The UK also did not see an increase in blood clots despite the AstraZeneca vaccine being their primary tool. As vaccine availability continues to improve in the US, a first dose and then delay option doesn’t make sense to me. In the next 6 weeks, there will be enough vaccine for everyone. Hopefully, there will be enough vaccination centers and availability of appointments as well. What the UK data may be good for is helping other countries that are behind in the vaccination game make decisions about who to vaccinate and how long a delay may be okay to get more first doses into people which reduces spread.
There was an interesting study out of Denmark published this week on reinfection rates. Scientists looked at reinfection rates among 4 million people during the second COVID surge in Denmark and compared infection rates to the first surge. Prior infections with coronavirus “reduced the chances of a second bout by about 80% in people under 65, but only by about half in those older than 65.” This led the researchers to conclude that recovering from the virus confers at least 6 months of immunity for the majority of patients. The question of immunity is obviously critical as we have many patients coming up on their one-year anniversary of being sick and as we wait to see how much immunity the vaccine provides.
To close, I’ll share a bit about my week. My last shift was Tuesday and I saw 0 COVID patients. Yep, 0. I think I had a couple of patients where I put on full PPE for their initial evaluation but they tested negative and were ultimately low risk. I wear an N95 for the whole shift, but it was kind of nice to have a day that resembled pre-pandemic patients. I spent Wednesday and Thursday in two different virtual conferences. First off, I have new respect for kids who have been doing virtual school and sitting at a desk all day. It’s exhausting and I should cut my 9th grader some slack when he tries to do class from the couch. Secondly, although we had lectures on COVID, it was great to medical education on diseases other than COVID. My brain has been pretty focused on COVID for most of last year. We had other projects in process in the ER last year, but most of the educational updates I got were related to COVID. These conferences covered all kinds of things that weren’t COVID and that is also a step towards normalcy. Yesterday was the Maryland ACEP annual educational conference. It’s a great conference and typically a chance to hang out with friends from around the state. Last year we had to decide if we were going to keep it live and in person, cancel it last minute (and lose our deposit on the site), or make it virtual. It was early in the COVID learning curve (it took place in early March before the lockdown but Covid was on our radar), we worked with the health department to come up with a way to make it safe and in person, while offering a virtual option. In retrospect, I’m glad it went off without a hitch or without a COVID outbreak last year. For yesterday, we had to make the decision early last fall if it was going to be in person or virtual and planning for a virtual conference was the right call. At this point, we’re optimistic we’ll be in person next year. I hope so.
Science matters. Wear a mask. Practice physical distancing.