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.
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.
Coronado Internal Medicine is dedicated to keeping our patients as healthy as possible and flu shots are an essential part of maintaining your health through the holiday season.
Despite many other diseases finding their way to the news, influenza is one the world’s deadliest widespread contagion. It’s responsible for hospitalizing thousands every year in the United States alone. Even very healthy people can get extremely sick and spread the flu to others. During recent flu seasons, between 80% and 90% of flu related deaths occur in those that are 65 years or older.
So the flu shot is an essential part of your health routine, especially for those that are approaching 60 years and older.
Make sure you come in today to get your flu shots. They are safer than ever and guard you from a potential sickness that spreads quickly in schools and the workplace!