COVID 19 Updates
Now that more people are being immunized, I am getting more questions about what activities may be ok to do again. Patients are wondering if going to the gym or eating out can now be done without risk of infection. To answer that question, I need to elaborate on what is going on this week.
In Houston Texas, a small group of people were found with extremely high viral loads and relatively mild disease. This group subsequently infected many individuals supporting a current theory known as the 20/80 rule. It is believed that 20% (or less) of the population causes most infections, and consequently the continuation of the pandemic.
In this Houston group the current predominant strain (D614G) was isolated, yet it is believed that by the end of March or early April this strain will be surpassed by the UK/British variant strain B.1.1.7. Thankfully, the British variant remains sensitive to the Pfizer and Moderna vaccines.
However, there are additional variants which are not. The South African strain (B.1.351) is the most concerning, as that is spreading rapidly through the world and is less responsive to the Pfizer and Moderna vaccines (although they do offer some protection).
With more genomic sequencing of the virus, additional mutant strains are now being identified, and so far, seven additional variants unique to the US have been found. At this time, it is unclear how significant these US variants are, although one (from Southern California) has been isolated here in Arizona in addition to the British variant. So far, no cases caused by the South African variant have been identified in Arizona.
One hypothesized worry about vaccines is that someone immunized can still be an asymptomatic carrier of the virus and pass it on to someone else (remember the 20/80 rule). Variant strains not as well covered by the current vaccines could make this transmission more likely. Indeed, it is theoretically possible that an immunized individual could infect another immunized individual with a resistant strain.
So, even though someone may be immunized, they are not necessarily completely protected. Hence, the continuing advice of staying socially distanced and wearing masks when around others. Eventually, when over 70% of the population is either immunized or has natural immunity, these concerns will most likely ease, yet it will be at least another 3-4 months before that occurs.
Therefore, it is ok to go to a gym if you continue to wear a mask when there with others. Eating in a restaurant is a bit trickier, since obviously you need to remain unmasked, yet if done in a larger room with few people this is probably ok. Eating outdoors or a similar open-air environment would be preferable. Getting together with family who have all been immunized or have recovered from an infection is also probably ok yet remember that most of the spread of the last few months occurred in small family get togethers.
The most frustrating aspect of Covid is the unknown. We continue to understand the virus better as time goes on, so it is likely that some of what we believe today may be disproven in the future. Nonetheless, we are limited by what we know and need to advise accordingly in order to bring this pandemic to a quicker end.
I will be back next week with another update. Take care.
Like the rest of the nation, Arizona is experiencing a dramatic increase in the number of Covid 19 cases. Our 7-day average for new cases is now up to 1082 which is up from 879 last week and more then double the average of 480 new cases back on October 1. Likewise, the statewide 7-day average for intensive care unit patients is increased from 172 last week to 188 yesterday. It was 125 at the beginning of the month.
Encouragingly the death rate remains low, especially considering the large increase in number of cases. The 7-day average for deaths in Arizona is 8 which is lower than it was a week ago and half of the 16 deaths a day occurring back on October 1. No one completely understands why this rate is remaining lower, yet one possibility is that the predominant strain of the virus is now more contagious yet less deadly then strains from a few months ago. Also contributing to this lower death rate may be our better understanding of how to treat more seriously ill patients.
In past messages I have singled out South Korea as a model for how I felt we should have responded to Covid 19. However, Taiwan just reported 200 days without a new Covid 19 case, and their approach deserves mention. Due to their experience with SARS (which is a similar virus) in 2003, they had an emergency central government agency which was activated to coordinate testing, PPE production and cooperation amongst various government ministries. They also began aggressive contact tracing and speedy isolation of close contacts of infected individuals. As an island nation, they did have an advantage of more easily restricting travel, yet they were very early in recognizing the threat, and began screening travelers from China in December 2019 and shut down travel into Taiwan in late Jan 2020. They did not do a country wide shut down. While concerns about privacy make similar contact tracing harder in the United States, we need to learn from other countries successes and emulate them.
I would like to update everyone on what we are doing in the clinic. Like most, we struggled in the early months with Covid 19, trying to figure out the right balance of keeping people at home while still seeing those who needed to be seen. We resumed doing Wellness Exams and routine visits on a reduced schedule in the summer, just as our cases in Arizona skyrocketed forcing another slowdown. In addition, our employee count reduced to just 1 full time and 1 part time assistant which greatly impacted our ability to be proactive. Since the end of the summer however we have hired 2 new medical assistants and now have 3 full time and 1 part time staff members. This increase will allow us to be in better contact with patients. However, while we are working hard to schedule as many Wellness Exams as possible, we are still only running at 75% capacity due to social distancing demands. Our hope is to catch up in early 2021.
Finally, I would like to remind everyone of two long standing clinic policies. First, we ask for 72 hours for refill requests. While we can usually do them much more quickly, this timeline helps assure you will not run out of medication. Secondly, if you have not heard back in 5 days on a lab or imaging result, you should call the office for the results unless you have an appointment to review them later then that. Thank you for allowing us to care for you and I wish everyone a peaceful week.
We believe we are seeing a flattening of the curve again, meaning the growth of new Covid 19 cases in Arizona has slowed down. We are now averaging around 2400 new cases a day, down from just over 3000 a day two weeks ago. However, this change still represents a much higher plateau then we ever expected.
The number of deaths unfortunately continues to go up. As of today, we now have 3,694 deaths in Arizona officially attributable to Covid 19. Nationwide, there are just over 150,000 reported deaths.
On the good news side, hospitals here in Tucson have fewer patients with Covid19, and patients are no longer being sent out of Tucson for care. Indeed, at TMC (where I am on staff), the number of beds committed to Covid patients is being reduced, and this week the number of patients with confirmed Covid is about half of what it was last week.
When the virus was first spreading at the beginning of the year, there was a belief it would behave like the flu and other respiratory viruses and become less frequent in the summer. We clearly have not seen that happen, and even in countries that have done a much better job then the US in controlling the virus, there continue to be outbreaks. We now realize that at least for the immediate future we will not see the virus return to low levels, and that the main hope for controlling it rests with a vaccine.
There continues to be encouraging information on vaccines, with one candidate entering the final phase of testing, and two other candidates soon to enter that phase as well. As I pointed out in another message, these phase 3 trials do not always end successfully, yet so far the data from phase 1 and phase 2 trials has been good. Specifically, the Moderna vaccine has been shown to achieve impressive results in Monkeys.
Since the different vaccines which are furthest along in testing utilize different methodologies, it remains unclear which one might work the best. I believe the Covid vaccine story will be like the Polio vaccine story of the 1950’s. The Salk vaccine was the first one available and was a wonderful development, yet it was the Sabin (or oral) vaccine introduced just a year or two later that proved to be the safer and more effective one.
Finally, I must continue to emphasize the need to wear a mask or other face covering while in public. It remains the single best way we have to prevent the spread of the virus. Take care and have a good week.