The CDC changed the mask recommendations. This is huge news, was made in response to the number of vaccinations that have taken place and how effective the vaccine is, but I actually want to start with the Pfizer vaccine news.
Earlier this week, the EUA on the Pfizer vaccine was extended to include 12-15 year olds. This was celebrated in my house. The FDA authorizing this was the first step before the studies were reviewed by the vaccine advisory panel, signed off on by the CDC director, and then ultimately, each state governor. I haven’t been able to schedule my son yet but hope to get him his first dose in the next week or so. I’ve loved seeing pictures of so many of my friend’s kids who got vaccinated on Thursday, the first day this age group was eligible. The study itself was pretty interesting. 2260 participants, aged 12-15, were included in a blinded, randomized, placebo-controlled study. There were 1131 patients who received the vaccine and 1129 who received placebo. The side effect profile was similar to the 16+/adults with injection site pain, headache, muscle aches, fever, etc…Effectiveness was broken down into two parts. First, 190 participants had immune responses measured which were at least similar to adult levels. Compared to 16-25 year olds, the younger age group had a strong immunogenic response 1 month after their second dose. Researchers also looked at infection rates. As it turns out, there were 16 cases of COVID among the 2260 participants. All cases of COVID occurred in the placebo group. In other words, for this age group, the vaccine was 100% effective. Real life data will probably show some breakthrough cases, but starting with 100% effectiveness from the studies is fantastic, and higher than we saw in the adult population.
Getting the 12-15 year old approval is important towards reaching herd immunity. I’ll add in that there’s still some opportunity for the 15-18 year olds as well. Based on my own observations, this group is not the most reliable with wearing masks and physically distancing themselves from others. More importantly, the pediatric population continues to make up an increasing percentage of new cases. I see announcements from my son’s school about positive cases and I hear from friends about positive cases among their kids (and friend group) and transmission from school parties and get togethers. Most concerning to me was a friend who told me they knew there were symptomatic kids at the school whose parents made a conscious decision to not test the kids so they wouldn’t miss out on school, sports, end of year events, etc….If we can’t rely on people to get tested and stay home if they’re sick, we really need to get them vaccinated to decrease their risk of getting sick. (As an aside, I’ve taken care of patients over the past year who told me they wouldn’t be able to miss work because they needed to get paid even when I told them they had COVID and needed to quarantine).
Now, back to the CDC and masks. It’s amazing what a difference a day makes. Right? The down and dirty is that the CDC said you don’t need a mask if you’re fully vaccinated, regardless of if you’re indoors (though hospitals, airplanes, and other places don’t apply) or outdoors. This is based on the success of the vaccination process, but really based on the math and the likelihood of getting sick. 120 million adults are fully vaccinated and 1 dose has been given to over 158 million adults. With the changes in the Pfizer EUA, there is now the potential to vaccinate 17 million 12-15 year olds (there are 25 million 12-18 year olds—a super important group as we try to achieve herd immunity for a country of 330 million people. On the flip side, there are about 130 million adults who have not gotten vaccinated yet? For vaccinated people, the CDC is saying your risk of getting COVID is very low. If you get COVID, you’re likely to be asymptomatic or have minimal symptoms. If you do get symptomatic, you’re unlikely to need hospitalization. And if you do need hospitalization, you’re unlikely to die. There’s a lot of protection in there but there’s also a touch of risk. Of course, one of the biggest questions is whether unvaccinated people will wear masks. It’s not like we walk around glowing if we’ve been vaccinated. And vaccinations are down 42% compared to a month ago. However, large portions of the population are vaccinated and the real-world data on the vaccine’s effectiveness is very positive. As a bit of a control and data freak, I would have liked to have seen a plan ahead of time with thresholds the CDC was looking for to trigger this decision so it doesn’t seem so random. With that said, huge numbers of the population are vaccinated, the percent positivity rate is declining, the number of new cases is declining, and hospitalizations are declining. As a country, we will certainly be even better off in 6-8 weeks as large numbers of 12-15 year olds become fully vaccinated, and some of the vaccine hesitant also get vaccinated. On the flip side, if our number of new cases and other metrics look worse, we’ll say the decision was made prematurely. Personally, I’m really comfortable outside with other vaccinated people without a mask. I’m relatively comfortable in a restaurant without a mask. I’m a little concerned about a crowded indoor public environment since it’s likely 30-40% of the people there won’t be vaccinated. I’ll likely skip the really crowded bars at the beach for at least the beginning of summer. And of course, we’ll have to wait and see what the political leaders around the DMV determine about when to lift mask restrictions.
We received big news at the hospital this week. We are officially a Level II Trauma Center. We first announced our intention to pursue this certification at our annual ED Winter Party February 2019, so reaching this milestone is more than two years of work that involved hospital administration, the ED, the ICU, numerous specialists, creating a trauma division (which includes trauma doctors and several people who administer/coordinate/perform quality reviews, etc), and significant amounts of nursing work throughout the hospital and education. We estimate that we’ll care for 1000 trauma patients a year, keeping our Arlington County residents at their local hospital rather than have them transferred to GW or Fairfax by EMS. Additionally, it’s a win for EMS and therefore our county residents, as the ambulances will spend less time on the road and be more available to patients who require their services. Although we’ve had our trauma team in place for 18 months, our inspection and certification was delayed by COVID (naturally, like everything else in every other sector), but we’re excited to have it now.
The hospital has less COVID patients in it now than last week. I remember watching video of the COVID hospital in Wuhan as they discharged their last patient and closed the hospital last year. We are not there yet and may never get there but we continue to move in the right direction. Our number of new positive cases among symptomatic patients and the percent positive rate continue to decline. Our asymptomatic patients and total positive patients we diagnosis in the ER each week is also steadily declining. We are certainly getting back to normal.
One paper from the literature to mention. We always worry a little more when pregnant women get sick and require hospitalization. Due to the changes of pregnancy, these patients are physiologically different than non-pregnant women, so throughout the pandemic, we’ve had a lot more concern when pregnant women require hospitalization for COVID. Now we have a study looking at mortality rates among hospitalized patients who were pregnant women with COVID and/or viral pneumonia compared to non-pregnant similar aged women. Interestingly enough, the mortality rate was 3.5% among the non-pregnant group compared to <1% of the pregnant women. Pregnant women also did better than the non-pregnant group when looking at the subgroup of patients who required ICU admission and/or mechanical ventilation. In a previously published study, the mortality rate among pregnant women was two times higher than non-pregnant women so these findings were definitely a surprise. This study did not consider if a higher percentage of pregnant women required hospitalization than non-pregnant women of the same age. It also didn’t control for medical similarities so it’s possible that the non-pregnant group was medically more complicated than the pregnant women. Ultimately, more research will be needed and the best advice for pregnant women is to avoid getting COVID.
Science matters. Wear a mask. Practice physical distancing.