April 16, 2021 Covid update

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There continues to be conflicting information on the risks of Covid 19 in the news. For instance, just 2 weeks ago the CDC issued new travel guidelines stating anyone fully immunized may travel without any restrictions so long as they continue to wear masks while in public. Some states have even eliminated any restrictions on large crowd gatherings and mask wearing.

However, also in the news is the continuing rise of infections in certain areas of the country, and new reports detailing people getting Covid19 despite being vaccinated. In addition, the Johnson and Johnson vaccine has been temporarily stopped due to a small number of cases of serious blood clotting issues.

So how does one make sense of it all?

First off, we must understand that all our knowledge is being acquired as this pandemic progresses. Realize that what we state as factual today may turn out to be incorrect or incomplete just 2-4 weeks from now. However, we only can use the information we have at hand, so we are forced to advise and educate with those limitations.

With regards to vaccine protections, despite the new variants the vaccines do appear to be working remarkably well. No vaccine is perfect, and the very small number of breakthrough infections (less than 1%) is not concerning at this point in time. There is a big effort to more fully understand why these failures may be occurring, yet that information will not be available for a while.

Interestingly, while both technologies used in the Covid vaccines (mRNA and Adenovirus) have never been fully utilized clinically, the seemingly new mRNA methodology used in the Pfizer and Moderna products actually has science dating back over ten years and is not novel nor untested. With the Adenovirus vaccines (the Johnson and Johnson and Astra Zeneca products), there appears to be something on the Adenovirus used that may trigger the body in rare circumstances to attack platelets and cause blood clots.

Because all these vaccines are new, any reported serious side effect will lead to a pause in administration while experts take the time to analyze the data and figure out whether to continue using the product. In the case of Astra Zeneca, vaccines were continued (although not without some countries stopping its use altogether) I anticipate we will see the Johnson and Johnson vaccine return with some restrictions.

Finally, while case numbers in Arizona appear to be stable there is discussion in some parts of the medical community that the situation on the border represents a very real threat to cause super spreader events here in Arizona. Testing does not seem ideally coordinated and may not even be done in some areas, and consequently we are in a situation where “we don’t know what we don’t know” (as an infectious disease colleague of mine has stated). Until we have a much higher rate of immunization then the 33% that we currently have, Arizona (and other southern border states) could be at a higher risk then appreciated. Only routine testing of everyone detained at the border will help us figure this out. So please continue to wear a mask in public even if you are immunized.

Take care.