I get my week-to-week positivity data on Thursday mornings. It’s the day we have been using since the very first report. My eyes popped open when I looked at the data yesterday. For the second week in a row, we had 0 new COVID cases among our symptomatic patients. And for the first time ever, we had 0 new COVID positive patients diagnosed in the emergency department when we looked at all comers. That’s amazing when you consider we run about 400 test a week. Unfortunately, it does not mean we are not taking care of COVID patients. We still see the occasional COVID who was diagnosed as an outpatient who then comes into the emergency department around day 4-5 when their symptoms start to get worse. But our numbers have looked so good now for the last 2 weeks, I am considering not wearing my N95 for the entire shift and just using a regular surgical mask again. The hospital is almost COVID free as well. We’re not quite there but we’re getting close. I feel very fortunate to work in an area where so many people have received the COVID vaccine, though I had discussions with two patients last night who were vaccine hesitant (I think I made progress with one).
Just like we’re seeing very low numbers locally, the vaccine continues to just show remarkable results protecting people from COVID. The AP analyzed data from the CDC and estimate that “breakthrough” cases among fully vaccinated people “accounted for fewer than 1,200 of the 853,000 COVID hospitalizations in May.” Looking at COVID related deaths in May, only 150 of the 18,000 deaths occurred in fully vaccinated people. CDC Director Dr Rochelle Walensky said it very clear, “nearly every death, especially among adults, due to COVID, is entirely preventable.” At this point, there really are two populations when it comes to COVID—the vaccinated and the unvaccinated.
It was a big week for vaccine discussion so let’s touch base on the Advisory Committee on Immunization Practices (ACIP) meeting from Wednesday. This was the meeting to discuss myocarditis related to the vaccine, postponed from the previous Friday. As healthcare workers, we talk to patients a lot about the risk benefit ratio. Here’s the numbers according to Dr Walensky—vaccinating 1 million 12-17 year olds we could see 30-40 mild cases of myocarditis. In the same million vaccinated population, we avoid 8,000 cases of COVID, 200 hospitalizations, 50 ICU admissions, and 1 death. “The benefits far outweigh the risk.” My son is now two weeks out from his second shot. Did I ask him about chest pain and shortness of breath for a couple of days—yes, because I’m a parent. But I never considered skipping the vaccine altogether or even the second dose.
There was also discussion about booster shots. It does not appear that we need booster shots at this point (though it seems likely that immunocompromised people may require a booster or a third shot—more research is coming). There will be more studies coming out later this summer and fall looking for evidence of declining protection (decrease in antibody levels or increase in cases) and/or evidence of a variant that escapes the vaccine’s effectiveness. I’m not seeing much on J&J but the CDC is not recommending getting a mRNA vaccine either. There also wasn’t discussion on the risk/benefit of people skipping the second dose if they had COVID prior to the first dose.
The delta variant continues to be a concern around the world and in America. Scotland represents a well vaccinated country who had their highest number of new cases in one day earlier this week. The Delta variant was the predominant reason for this rapid growth in cases. Within the U.S., the Delta variant has doubled in the past week from 10% to 20% of new cases. This is a rapid progression and will lead to many more cases throughout the country. Particularly hard hit are areas of the country where the vaccination rate is low. The data is showing that the vaccinations are doing very well to protect people from getting COVID related to any of the variants.
One of the concerns that frequently comes up as a cause of vaccine hesitancy is the concern affecting fertility. Keep in mind that the mRNA vaccine does not impact our DNA. That is basic science that my son learned this year in ninth-grade biology. That bit of basic science should be enough to allay concerns. But I understand that some people want to see more advanced research. Published in JAMA this week is a study looking at sperm parameters before and after mRNA vaccine administration. Male fertility is related to the quality and amount of sperm produced. The University of Miami recruited healthy volunteers from the ages of 18-50 who had not had COVID within 90 days and were going to get the vaccine, and looked at their sperm characteristics before and after vaccination. And just like in any cross section of men, there were a small amount of men in the study who had issues with low sperm counts or motility. However, across the board, they did not see any impact to the sperm parameters after 2 doses of messenger RNA vaccine. The authors did state that they did not expect to see any impact of the sperm because the vaccine contains mRNA and not the live virus. This study should provide some reassurance to men that their fertility will not be impacted by the vaccine.
The NEJM ran an article this week looking at vaccine safety in pregnancy. The authors use data from the “V-safe after vaccinating health checker” surveillance system, the V-safe pregnancy registry, and the vaccine adverse event reporting system (VAERS). Using this data, the authors found that the percentage of live births compared to those pregnant women who had “adverse pregnancy or neonatal outcomes” were similar in the vaccinated group compared to pre-pandemic pregnancy outcomes. Basically, miscarriage rates, fetal death prior to delivery, or preterm births were similar whether you were vaccinated or not. Based on this preliminary study, they conclude that there was no “obvious safety signals” among patients who receive the COVID-19 vaccine. The authors do add however, that based on the timing of the data they looked at, there is a need to review additional data for patients who are vaccinated early in pregnancy or were vaccinated just prior to getting pregnant. It seems very unlikely based on what we know about the vaccine in a study like this, that receiving the vaccine will lead to future fertility issues or that getting the vaccine will lead to issues having a normal pregnancy.
Science matters. Get vaccinated. Wear a mask when you’re supposed to. We’re almost there.