The April COVID-19 Column
A- John Hopkins University has reported more than 128 million of cases of COVID-19 in the world while 3 million death were noted. In the United States more that 30.5 million of COVID-19 cases and more than 550,000 deaths. The United States lead the world in cases.
The state of New-York has launched this month a COVID-19 digital pass for residents to download and show proof of vaccination or to attest a negative CVID test result. The document will be called the Excelsior Pass and will be accepted in all major venues like Madison Square Garden or Albany’s Time Union Center starting next week and would be able to be used in theaters, arenas or stadiums.
The company IBM developed an “app” and will allow people to carry an “Excelsior passport” to allowing them to gather safely while the state of New York recovers. Although the numbers of cases with active vaccination have risen after a plateau was observed for many weeks. Presently around 60,000 new cases pf CPVID-19 are observed every day in the country. This will have to be controlled to avoid the epidemic curve to soar again. A lot of controversy but it is not well accepted. Some are saying that the actual governor of New York has so much problems with the sexual harassment suits that he is looking for a diversion. Other Governors especially the one from Florida states that he will not accept this notion of passport.
Meanwhile, the CDC, Center for Disease Control and Prevention announced that the wear of a mask is still mandatory while travelling vaccinated or not. Over 60 million are fully vaccinated. Unvaccinated people are still advised not to travel.
Michigan identified the first case of Brazilian COVID-19 variant. World leaders of more than 20 countries called for an international Pandemic treaty for a global collaboration to battle future pandemics. Especially in the sharing of knowledge on the pandemic and their vaccines… The actual pandemic for the COVID-19 has ravaged the world since the first cases were observed in Wuhan during the late months of the year 2019. Since, 130 million of cases have been reported worldwide. Unfortunately, the most powerful country did not sign the proposition for the treaty including United States, Russia and China. Indeed, preparedness needs global leadership, guiding us in solidarity and fairness, equity and transparency.
There is an enthusiasm surround the coronavirus vaccines among ethnic and racial backgrounds especially when in the recent month of March which has seen an increase in the Black adult’s population of the US having with more willingness to take the vaccine as reported by a survey performed by the Kaiser Family Foundation. 64% of whites, 61% of Hispanics and 45% of Blacks are enthusiastic to take the vaccine. The skepticism seen in December 2020 was high when the vaccine become available and leaders in the black communities were perplexed. Even the new administration was saying that they did not thrust the vaccine of the old administration but they are rapidly sharing the benefit in the distribution. We have witnessed the wait and see attitude in March while at least 15 % were refusing to be injected. A judge ruled that New York states the need to provide the vaccine to the prisoners. Still, politics reign and more democrats (75%) attest that they will get the vaccine vs republicans (57%).
Canada is the last country to pause the Astra Zeneca vaccine following the list long list of countries we reported in the last AMHE Newsletter. There is substantial uncertainty about the benefit of providing this vaccine to people under the age of 55 given the potential risks. Blood clots were found to be a prominent complication two to three weeks after the vaccination in 1/100,000 vaccinated with the Johnson and Johnson vaccine.
This week, an independent advisory board to the CDC decided to restrict the use of the Johnson and Johnson vaccine but they did not feel comfortable to discontinue it because of the risk of blood clot discovered on 6 patients around the world involving a cerebral vein. Scientists are gathering more evidence to explain the occurrence of such lethal complication. It is an extremely rare complication but more data is needed for a truly review. Meanwhile more than 7 million of people have already received the single shot vaccine.
This Johnson and Johnson vaccine was seen as a solution for the hesitancy of many because more individuals were interested in taking a one-shot vaccine. The vaccine was also inexpensive bringing also a way to approach the less fortunate. This restriction will affect the distribution process and may jeopardize the goal in reaching the desired immunity.
Cerebral venous sinus thrombosis is generally accompanied by a thrombocytopenia (low platelets) favorizing clotting. The cases apparently are seen in women between the age of 18 and 48. A young 25-year-old male exhibited symptoms similar to the women. Clots can be found in other parts of the body as well. People complained of headaches, one to two weeks after the vaccination. The hold on for the vaccine is also to make the primary care physicians and generalists, aware of the problem especially when the initial treatment may require the use of a blood thinner Heparin which could make the symptoms worse as well.
The CDC wanted also to caution the public in general for the one who have already received the Johnson and Johnson vaccine to remind them to come forward if they experience any of the symptoms described. A final decision is expected to last weeks and maybe months. During this time the Moderna and Pfizer-BioNTech products, both mRNA vaccines, will be used to compensate the lack of Johnson and Johnson or Astra-Zeneka vaccines based on adenoviruses.
B- The fourth wave of COVID-19 is now at the doors of the United States of America and we need to remain vigilant. This attitude taken by many that they have already taken their vaccine so they do not need to be protected by a mask is heard all over the country. Our scientists were grilled by the senate and the congress for the rationale they use to enforce the use of the mask after being fully vaccinated. The CDC continues to report up to 10,000 new cases every day. It seems that during the third wave more than a quarter-million Americans tested positive for the virus daily.
While millions are receiving their vaccinations toward achieving herd immunity, cases are rising in states like New York, New Jersey, Connecticut, Pennsylvania, Michigan pushing the CDC to claim a fourth wave. People are tired of wearing mask or being isolated. They want to feel free of doing whatever they want.
In the early weeks of vaccination against the COVID-19, many have claimed victory especially among the politicians. Countries like Israel, Great Britain and the United Arab Emirates have been exemplary with their success with the vaccination of their population. In the United States of America, states like Alaska, West Virginia and perhaps Connecticut have responded well. In New-Mexico we noticed the higher rate of vaccinated people despite of having the highest rate in poverty. In Connecticut people older than 50 have a priority in receiving the vaccine.
C- The CDC announced that the two doses of Pfizer-BioNTech and Moderna vaccines are highly effective preventing COVID-19 with a 90% effectiveness against the disease while if you have taken only one dose you have as well 80% of effectiveness. So the vaccination program is effective. There id hope that we may reach this level of herd immunity thar we are looking for.
Arizona, Iowa, Mississippi, Montana, North Dakota and Texas have lifted their mask mandates and have allowed many business-like restaurants and bars to open their doors. Cases are climbing in more than 30 states and hospitalization rates increase to 4700 with a death rate of 1000 / a day. Around 2.6 million of doses are administered each day. 47 states are going to extend the vaccination to the age of 16 and older. Scientists are studying if vaccinated people can spread the virus as well.
D- Pfizer-BioNTech and Moderna were found safe to be given to pregnant women. They showed also effectiveness in producing antibodies in the mother and the baby. 84 pregnant women, 31 breastfeeding and 16 non pregnant women were all part of a recent study to check on the development of antibody after the Pfizer or the Moderna vaccine. The study found no difference in side effects between the women who accepted to take the vaccine, pregnant or not. Some who received the Moderna showed a higher titer of antibodies. The women can also pass these antibodies to the fetuses and newborns
E- Researchers have also found neutralizing antibodies in the blood of pregnant women which surely indicated that the antibodies have killed the coronavirus. More research will be needed to know why these neutralizing antibodies. Additional study will be needed for the other vaccines. These mRNA vaccines seem to provide at least 6 months of protection.
The South African variant has been the most concerning variant so far and the Pfizer products are protective against it and surely as well against the British strain.
Maxime Coles MD