Covid19 update Jan 25, 2021

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Vaccines for Covid19 remain the major focus of our approach to ending this pandemic, yet vaccines will not have a noticeable effect for a few months. As we approach our eleventh month of dealing with Covid19 the guidance given to wear masks and, more importantly, to keep at least 6 feet apart from others when around people you do not live with, continues to be the most valuable way to reduce the spread of this infection.

With regards to masks, when out and about it would be best to wear a Niosh N95, KN95 or K94 mask. These masks can protect the person wearing it as well as anyone around them. They are generally superior to cloth masks yet are tighter fitting and thus can be more uncomfortable. The KN95 is perhaps better tolerated yet needs to be FDA approved as there are many KN95 masks sold which are not protective. On my website I will place links to 2 companies that sell certified masks at a reasonable price.

From my perspective as a physician, Covid19 is both fascinating and frustrating. Intellectually, all the research and knowledge obtained on this virus in just a period of a year is unparalleled in modern medical history. Clinically though, Covid 19 is a nightmare, with great uncertainty on how to treat it, and more concerningly, a tremendous unpredictability.

With many infectious diseases, it can be obvious if someone is going to recover (albeit slowly) or not, yet with Covid19 someone may be doing well and then suddenly decline and die. Age is not an ideal predictor of risk, with newer mutant strains of Covid19 appearing to infect younger people at a higher rate then prior strains. Similarly, people without any obvious underlying conditions may die while others with chronic illnesses get better. To a certain extent, this has always happened, yet not like it does with Covid19.

Mutations of a virus are common, and there are two mutant strains of Covid19 which are concerning. First off, is the UK or British strain which appears to be much more infectious. Over the weekend, there was speculation it may also be more deadly, yet that is not entirely clear yet. Second is the South African strain. This particular mutation is especially worrisome since it alters the spike protein configuration. The spike protein is what helps the virus infect cells and is also the target for the two vaccines currently being used in the US (the Pfizer and the Moderna vaccines).

The worry is that these mutations may make vaccination less effective or not effective at all. So far with regards to the British variant that does not appear to be the case, yet concern is high enough with the South African variant that Moderna has started working on a modified version of the vaccine currently being used.
Another fear is that if immunizations are not completed rapidly enough, vaccines may select out for an even more resistant strain of the virus then those we know of today. This point has been speculated upon in countries like Israel where up to 25% of the population has already been immunized with the Pfizer vaccine. There is NO proof this will happen, and it is not a reason to not get vaccinated.

Because the vaccines are new, there is great scrutiny on any bad events which occur after getting them. Unfortunately, with any vaccine there is always a small number of individuals who have a severe or even life altering reaction, yet the number of people this happens to is extremely low, usually in the range of one out of a hundred thousand people or less.

The most likely reaction from a Covid vaccine is going to be a sore arm. Some people also experience headache, fatigue, and fever. Interestingly, in the approval studies for the Pfizer vaccine, those under age 55 were more likely to have a reaction.

Finally, I was hoping to discuss how best to get a vaccine yet unfortunately there is no easy way to achieve that. Arizona would like to get 400,000 vaccine doses a week yet currently is only receiving 169,000. This discrepancy is limiting the availability of appointment slots for vaccines. However, in the next few weeks this situation will probably improve dramatically, with vaccines becoming available in pharmacies as well. I will keep you updated. Take care and have a wonderful week.