Earlier today, a CDC advisory panel says the benefits of the Johnson and Johnson vaccine outweigh the risk and that we should resume using the J&J vaccine. You’ll recall that this is the vaccine with a very small risk of a very severe blood clot that is associated with low platelets. But this vaccine offers benefits with it’s ease of use—one dose and not requiring such frigid storage conditions, and it’s possible it will be back within days (likely with a warning that blood clots are possible). I said before that the future of the vaccine would come down to math. The CDC has confirmed 15 cases of this rare blood clot with the J&J vaccine with a rate of about 7/million vaccinated women in the 18-49 year age group and 0.9 per million in the 50+ female age group. No men have been affected yet. They also estimate that for one million J&J vaccinations given, there will be 2000 fewer COVID deaths and 6000 fewer COVID hospitalizations.
In a study out of New York published in the NEJM, breakthrough COVID infections (getting COVID after being fully vaccinated) has been shown to be rare. Perhaps only 0.5% of vaccinated patients. However, the CDC reported two large breakouts from nursing homes. One case study out of Kentucky started with an unvaccinated employee who transmitted COVID to 46 patients and staff, including 26 residents (18 of whom were vaccinated) and 20 staffers (including 4 vaccinated) Unvaccinated residents and healthcare workers were 3.0 and 4.1 times the risk of infection as the vaccinated residents and HCWs, showing the vaccine to be about 87% effective against symptomatic illness. All of the infected people were infected by the R.1 variant. Although 90% of the residents of the nursing home were vaccinated, a much lower percentage of the employees were vaccinated. A second breakout in Chicago had 22 staff and nursing home residents test positive more than 2 weeks after their second vaccination. Two thirds were asymptomatic but 2 required hospitalization and there was one death. It’s outbreaks like these that I hope will lead to mandatory vaccinations once the vaccine receives full FDA approval. Yesterday, the University of California and Call State systems announced that they will require the COVID vaccine for in-person classes this fall. Expect more and more schools and jobs to follow.
This headline in the NEJM two days ago really caught my attention: Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. I know a lot of young people are really concerned about potential fertility issues down the line. Even though the mRNA vaccine doesn’t change our DNA, getting more and more data in front of people should help convince the people who remain fearful. Scientists looked at about 35,000 pregnant women using various vaccine registries and found that the vaccine was generally safe in pregnancy and the “proportions of adverse pregnancy and neonatal outcomes (e.g., fetal loss, preterm birth, small size for gestational age, congenital anomalies, and neonatal death) among participants with completed pregnancies from the v-safe pregnancy registry appear to be similar to the published incidences in pregnant populations studied before the Covid-19 pandemic.” I know a lot of HCW who got vaccinated and have since had healthy babies. With all of that said, these are preliminary results since they’ll want to follow more pregnancies to completion in women who were vaccinated prior to pregnancy and also those vaccinated during pregnancy.
COVID hospitalizations have dropped 80% among those >65 years old since the vaccination became available. But nationally, we’re seeing increases among the 50–64-year-old crowd. There is an argument being made that this age group should be the vaccination priority since it will lead to less morbidity and mortality. But since every adult in America is eligible and it’s easier and easier to get a vaccine, I continue to be in favor of vaccinating anyone and everyone based on who shows up.
I worked a lot clinically over the past week. I think I only diagnosed a couple of COVID patients. I’m back in my white coat and it seems pretty normal, if normal is an N95, eye protection, and a box of gloves next to my computer so I have them for every patient. We’re seeing some of the impact on vaccination in our own patients. Our ICU has younger people and less minorities now than prior to the vaccine. Most of our hospitalized patients have not been vaccinated or have had only 1 dose of vaccine. The hospital has a similar number of hospitalized COVID patients (same ballpark as the last couple of months) though our overall percent positivity rate continues to improve. In the ED, we are seeing a return of patients requiring emergency services (our daily volume is up about 12% compared to March and COVID is not the majority of what we’re seeing. We are slowly trending in the right direction when it comes to COVID testing. The total number of patients we diagnose with COVID is down a touch and better than 6 weeks ago. Our percent positive rate is also trending in the right direction. The number of patients who require COVID isolation has increased but that’s likely due to the volume bump we’ve had in patients. Fortunately, the total number of these patients requiring admission is also trending down. At this end of the day, these numbers are as good as I’ve been able to report since last summer. COVID is not over but as vaccinations continue, I’m optimistic our numbers will continue to trend in the right direction.
We still need to keep an eye on what COVID is doing around the world. We will not be out of this until the world is in better shape. Canada is still behind us in vaccinations and currently in India, only about 9% of the population is vaccinated and hospitals are full. There’s a lot of areas of the world that still need a lot of help. Without helping the rest of the world, we are just a variant away from another outbreak throughout America.
I’ve wanted to write about FOMO for several weeks. I think I first heard the term from the nurses I work with who were in the 20’s about 5+ years ago. Recently, I heard my mom use the term. She wasn’t talking about “Fear of Missing Out” but rather “Fear of Moving On.” COVID has forced us to evaluate our risk tolerance. For lots of people, there was considerable risk last year. But with vaccinations and thoughtfulness, it is possible to start taking steps back to normalcy. I’ve had some meetings with contractors recently. We’re vaccinated and outside and I’ve cut way back on wearing masks in these situations. I’m looking forward to some planned social events with other vaccinated friends. I’ve had friends who have been eating indoors at restaurants for months. I haven’t wrapped my head around that yet, but I think in the right situation, I’m good with it. We do have to wrap our heads around the actual risk versus the fear we’ve accumulated the past year. I’m probably not going to an indoor concert anytime soon but there are a lot of things we can start to do that are pretty safe. Not 100% risk free, but to me, approaching acceptable risk to put some of our current FOMO behind us.
Please get vaccinated. And bring a friend with you.
Science matters. Wear a mask. Practice physical distancing.