Hot off the presses, and hours after I finished drafting my Friday night update (which starts with the next paragraph), Pfizer has requested an amendment to their original EUA for the 12-15 year old age group. The FDA process will take weeks but it’s likely that kids in that age group will be able to get the vaccine as summer is starting, not just in time for school. As I said last week, my son is in that age range and I will be very happy when he gets vaccinated.
There have been some great publications over the past week that answer questions about blood type, fomite transmission from surfaces, and how much excess death there has been this past year. I’ll also get into mandatory vaccinations for college students and in the work place, but let’s start with what’s going on at the hospital.
COVID has maintained the status quo around the ED and the hospital. Our inpatient census and new diagnosis patients in the ER have ticked up a notch but we are not experiencing the surges seen in other states. Our positivity rate among symptomatic patients in the ER is higher than last week but similar to our 6-week average. That holds true for our overall positivity rate as well–higher than last week and more total new COVID diagnoses, but only slightly higher than the 6 week average. Earlier in the week I took a look at the ages of the hospitalized patients. While the majority of hospitalized patients are >65 years old, the rest cover every decade from twenties through fifties. It’s hard to ignore the rising numbers on the state and national level of increasing cases and having the UK variant be the dominant virus identified while racing to get more and more people vaccinated. The DMV is seeing more cases and increased hospitalizations. Michigan is having discussions about delaying elective surgeries. (BTW, Michigan is seeing all time high numbers for teenagers so how much hope does the Pfizer vaccine give them). We haven’t postponed elective surgeries since last summer. People are still getting COVID as the UK variant is more transmittable and while vaccinations are pretty available, we’re not done with COVID yet.
I’ve had several discussions this week about mandating vaccines for college students and employees in different jobs. While being far from a labor attorney, my understanding is that it’s legal to require vaccinations with the carve out for religious beliefs, medical issues, etc…This is true whether the vaccine is FDA approved or under an emergency use authorization. Last December, my take and many in healthcare was that because the vaccine came out under an EUA, we didn’t believe we should make it mandatory at the time. It was new technology and therefore, we had limited experience with the vaccine, and there was also months of concern about how quickly the process occurred. I got my first shot about 5 months ago and 175 Million dosages later, we now have tremendous experience and research with the vaccine showing it’s safety and efficacy. There certainly must be enough data to obtain FDA approval for the Pfizer and Moderna vaccines and my understanding is they plan to apply for that. Several universities announced this week that they will require the vaccine for on campus students this fall. Again, universities have long required mandatory vaccinations and it’s legal. I think many parents who may be reluctant to have their kids get vaccinated may be more comfortable once the FDA approval process occurs. Maryland (and Virginia) have opened up and my 20-year-old (and many of her friends) have received at least one dose of vaccine. Certainly, when you look among the age groups that lead to the most spread, getting control over this virus will be expedited by making sure the college age, and young adults, get vaccinated. I suspect more and more colleges will require vaccination before the fall and don’t be surprised to see workplaces do it as well.
There were a bunch of interesting articles that came out this week. Many of these covered topics we’ve been discussing for a year and we now seem to have some clarity.
First, we’ve been questioning whether there Is a relationship between blood type and COVID susceptibility or severity. There was an early report out of China last year that people with blood type A were at higher risk and that blood type 0 had a lower risk. Follow up studies from Italy and Spain had similar findings. However, observation studies out of Boston and NYC did not find the same outcome. From JAMA online this week, researchers from Utah did a case control study of nearly 108,000 patients who underwent COVID testing. Looking at data of both positivity and hospitalization, they did not find a relationship between blood type and outcome. They do caveat their conclusions that further studies “closely controlled for genetics, geography, and viral strain, are required before accepting blood group as a determinant of predisposition to or severity of COVID-19.” For now, though, if you have type A blood and were stressed because you thought you were at higher risk, you can take a deep breath. And if you weren’t worried because you had type O, be sure to keep your mask on and get vaccinated.
The CDC released data on the risk of getting COVID from touching surfaces (fomite transmission). Think about all that “fog spray” we saw used around the world last year and how hard it was to get Clorox wipes—all because we needed to wipe down counters regularly. We now know that the overwhelming majority of COVID spread is through respiratory droplets, thus the importance of masks and physical distancing. There have been case reports of patients who have gotten COVID by touching contaminated surfaces, but the CDC is assessing that risk as 1 in 10,000 for each contact with a contaminated surface. Those are extraordinarily favorable odds. There are distinctions between indoors and outdoors as well as porous and non-porous surfaces (like stainless steel, plastics, and glass). In general, the virus tends to die quickly outdoors and can last up to 72 hours indoors. But there are some differences between lab and real-world conditions, involving the amount of virus, how much virus is actually picked up by contact from surface to hand and then from hand to mouth, as well as factoring in ventilation. Routine cleaning with soaps and detergents can reduce virus levels on surfaces. Though if surfaces have been contaminated by a suspected or known Covid positive patient in the last 24 hours, a disinfectant should be used. Hand sanitation continues to aid in our defense from infection of contaminated surfaces. At the end of the day, getting COVID appears to be very low risk from touching a surface, particularly outdoors, and it’s nice to have the CDC release data that will decrease the stress of getting back to normal.
Also, recently from JAMA was a study looking at total deaths from March 1, 2020 to January 2, 2021 and how the actual numbers relate to the expected numbers. The researchers found a 20% increase in excess deaths or about 522,368 more than expected. The highest rate of excess death occurred in non-Hispanic Blacks and overall, excess deaths occurred in 4 distinct surges over time in different regions of the country. Excess deaths occurred in all regions towards the end of 2020. Deaths attributed to COVID represented about 72% of all excess deaths, leading researchers to question whether there were some deaths that were not documented as COVID or if people died due to non-COVID reasons but still related to the pandemic (behavioral health, substance abuse, delayed care for medical issues).
With all of these excess deaths and the impact of COVID on younger adults, there was a study also published in JAMA looking at kids who lost parents from COVID. “They found that for each of the approximately 480,000 deaths as of February of this year, .078 children aged 0 to 17 were left bereaved of a parent, representing a 17.5% to 20.2% increase in parental loss that would have occurred in the absence of COVID-19. That translates to 37,300 children who had lost at least one parent as of February, with approximately 75% of them being adolescents ages 10 to 17, researchers said.” It’s just an extraordinary lasting impact to a huge number of kids that will have an additional hurdle to overcome because of the pandemic. They also looked at the potential impact to children had natural herd immunity been allowed to occur and believe that an additional 117,000 children would have lost a parent.
Please make arrangements to get your vaccine. I was in two different CVS stores this week and each had open spots.
Science matters. Wear a mask. Practice physical distancing.