May 2021:
Column on the Coronavirus Pandemic

SARS-CoV-2 virus is changing but still making its impact around the world. The United States continue to lead the world in number of cases of COVID-19. More cases have also been reported worldwide earlier in this month of May as reported by the World Health Organization: 5.30 million of 8 million of new cases in the world and a total of one hundred fifty-two million in total cases and 3.17 million deaths. The number of case count and deaths are dropping in the United States while it is rising around the world. New reports state that new cases fell from 15.8% and deaths fell by 3.6%. The daily average case fell to 57,500 compared to 248,000 in January 2021. 961 million of vaccine have been distributed.

Anybody over the age of 65 who has been fully vaccinated with the Pfizer/BioNTech or the Moderna coronavirus vaccines are 95% less likely to be hospitalized for COVID-19 compared to an unvaccinated person of the same age group. If anyone is partially vaccinated, then the CDC found out that they are 64% less likely to be hospitalized.

Everywhere in the world has reported more new cases except in Europe where a decline of 3% of the cases was noted. The South East Asia countries especially India has seen a surge of infection where 314,800 cases were recorded in one day, setting a world record cases in a single day. In January, the United States set as well a record with 300,600 cases during the month of January 2021. The B.1.1.7 variant originated from the United Kingdom appears to be responsible for the number of infected persons. It looks like there is a humanitarian emergency in this corner of the world.

The World Health Organization reports that India accounts for nearly one third of all new cases in the world with more than 16 million cases second to the United States with 32 million infected cases. Hospital shortages of bed. Medicine and oxygen are reported to a point that the judicial system ordered the government to divert oxygen from industrial use to hospitals deserving the population. India has enormous possibility for manufacturing mRNA vaccines.

1.4 million infection in one week in India, represents 64% increase in cases. Brazil and Turkey as well as the United states reported their high number of cases. These cases are related to the emergence of COVID-19 different variants. It does not appear that the pandemic is slowing down in spite of the tremendous effort to vaccinate. The death toll maybe higher than reported.

A-   Johnson and Johnson announced that it would resume shipping of his COVID-19 vaccines in European countries and Norway and Iceland with warning. The one-shot vaccine will protect communities in need around the world. I am not too sure this is a nice decision because this will affect the less fortunate. The US has also followed the recommendations with a warning for a possible relation between the vaccine and blood clots formation. The restrictions are lifted.

People need to be aware of the complications of a very rare blood clot formation in the two to three weeks after taking the vaccine. We know that COVID-19 is well associated with a high risk of hospitalization and death, but a low platelet count and a blood clot formation is also a rare complication specific to the Johnson and Johnson vaccine. This complication was encountered in 6 cases around the world, most of the were women between the age of 18 and 48. A seven case reported was in a young man. The vaccine is still on hold in the USA, although the distribution has re-started in Europe. More than 7 million of people have already received the on- shot vaccine.

A reported news from the FDA states that 15 million of doses of the J and J vaccine, not stored properly, were found to be contaminated at a Baltimore plant with peeling paint as well as residue on the floors. Vaccine production has paused in the Baltimore plant and stocked vaccine has been stored. The stocked vaccine will undergo additional check. That plant in Baltimore is the site for the fabrication of the J and J vaccine as well as the AstraZeneca vaccines. Workers apparently mixed-up ingredients for the two vaccines.

B-   Vaccine hesitancy seems to be increasing among people born between 1997 and 2012, called the generation Z, as reported by the Philadelphia Enquirer. Health care experts are looking new way to encourage them to take the vaccine. Commercials on TV and Newspapers and other social media are posting announces as well to stimulate the young toward the acceptation of the vaccination. Pharmaceutical companies are bringing explanations on their vaccines undermining the authorities of the CDC. By examples. explaining the complications of the Johnson and Johnson vaccine was paused or other facts about the AstraZeneca brand vaccine.

Indeed, hesitancy is a challenge and a concern when the number of people looking for the vaccine has decreased not only by the fear of the needle but also with all the vaccine misinformation. Some believe that famous people are just in the frontpage of TV to encourage mainly the distribution of the vaccine, but in the public, some believe that the healthcare specialist may have used retractable needles to give the impression thar such person has received the vaccine. The public is fed with these images and they become confuse with the flow of information. Many haven’t a clear understanding of the risks-benefit analysis. Others believe that microchips are being introduced in their arm for better control by the government. Other are being fed by the possibility in becoming infertile once the vaccine is injected. Benefits are not too sure.


C-   The Biden administration just announced that it will make a donation of 60 million-Astra Zeneca vaccine-doses to countries in need notably India. They should have been able to diverge some toward Haiti, a country in the same hemisphere which has not been able to start any vaccination program or any African country in the same situation. But Johnson and Johnson which already has resumed shipping the COVID-19 vaccine to Europe after clearance was given by the European Union Health Agency, has added a warning for a possible connection to blood clots and low blood platelets, a very rare complication. As I have already stated, India has a lot of potential to produce the vaccine itself.

If the administration celebrated the speed of the country’s vaccination program, still half of the adults in the country have not received one shot of the vaccine. United States stands behind Israel, Britain, Chile and United Arab Emirates in the distribution of the vaccine after having heritage the vaccines from the previous administration. The daily shots given, have declined. The Johnson and Johnson vaccines were paused in the mid-April 2021 because of its association with the blood clot problem in the brain while the same problem encountered with the Astra Zeneca vaccine was approached differently by the British and they chose to put only a warning on it. We have already discussed the vaccine hesitancy with the generation Z above. To respond to the problem, 40,000 pharmacies were allowed to provide the vaccine to the population in need with no needed appointments. The program continues to work wishing to eliminate the hesitancy.

In the world, the WHO announced that more than 965 billion of vaccine doses have been administered but unfortunately this is not the same for the poor countries which leg far behind. More than half of the adults in the USA have received at least one dose of the vaccine. We will soon have to follow Israel, the leader of all country in the distribution of the vaccine who recently has lifted its outdoor restrictions in the wear of masks.

If Pfizer and it partner BioNTech have developed the first coronavirus vaccine for use in the United States and Europe. We are soon expecting a pill promised by Pfizer actually in development which will not be a vaccine but a drug to treat people who suffer from the COVID-19 infection like Remdesivir. It seems that this oral drug will work by blocking the enzyme protease that the virus needs to replicate. These medications are already in use in the treatment of HIV and Hepatitis C and clinical trials are on the way. More, by the end of 2021, we may even see on the market, an oral vaccine under the form of a pill which apparently is being developed by the Oravax Medical, an Israeli-American Company in cooperation with an Indian Company Premas Biotech.

D-   Much has been discussed about public bathroom and a new study has shown that a lot of the airborne pathogens were hanging around. You may not wish to hand too long in such place because of the results obtained on tests performed by the Florida Atlantic University’s College of Engineering and Computer Sciences on public restroom toilets and urinals. Notably, a three-hour test involving more than 100 flushes allowed them to measure and conclude that more than ten thousand droplets were generated in that period of time as reported by A professor in mechanical engineering, Siddhartha Verna.

Other viruses or pathogens even the COVID-19 virus can be bound in stagnant waters as well as urine, feces or vomit. Flushing these bathrooms can generate large number of airborne germs 5 feet away and they can last more than 20 seconds after the flush or they can be found between the cover and the seat. The particle can average 3 micrometers in size posing a significant transmission risk… or other smaller in size can remain suspended for a long-time.

Meatpacking plants recently were found to be the source of 334,000 COVID-19 cases in the United States, and apparently those numbers are conservative especially in the Beef and Pork packing plants. The pandemic led to a massive disruption in the food supply chain justifying a food prices increase. These observations were reported in the Journal Food Policy and more information can be retrieved from the CDC (Center for Disease Control and Prevention) for meat-poultry plants and COVID-19).

E-    Women are reporting more severe side effects after receiving the COVID-19 vaccine than men often related to hormonal or genetic conditions or to the vaccine dose itself. Recently the CDC reported that in 7000 people with side effects from the vaccine, 79% were women: 19 had anaphylactic reaction with the Moderna vaccine while 44 had the same problem with Pfizer. It was well known in previous studies that 80% of women have demonstrated anaphylactic reactions to vaccines. We have seen it with vaccine against Hepatitis B, Measles, Mumps or Rubella.

It is believed that women have a more robust immune system producing more antibodies perhaps because of their response through hormonal support of Estrogen or Progesterone or even Testosterone. If estrogen has tendency to have the body overproduce antibodies, it seems that testosterone has the inverse effect at suppressing it. More the immune-related genes are located on the chromosome X and women have 2 copies of it while the men have only one. The COVID-19 vaccine will create different responses or side effects among men or women but most of the time, the reaction is mild.

The Moderna and The Pfizer vaccines are safe and efficacious in the fight against the COVID-19 virus and its variants preventing hospitalizations and deaths. We hope to reach the Herd Immunity once we able to vaccinate more than 70% of our populations around the world. Surely, the virus will not disappear but it will remain around while people will dispose of a better armamentarium to fight it. So far, if 580,000 American have died as well as 19,300 million around the world, it remains in our reach to start the vaccination of the teen-agers aged 12-15.

We may experience another crisis during the next winter season and we hope that the efficacy of the vaccine will attenuate the mortality rate. We may have a need for a booster vaccine especially in front of all of those variants seen around the world. I am not too sure that the new approach of the people of Israel which has dropped in their wear of mask outside is the proper way to move forward with this pandemic but we will let the scientists guide us in the proper venue. Many has to put in their mind that we will not be able to eradicate this virus from the planet like we did with Smallpox.

F-    There is a humanitarian crisis in India where in the last six days of April to the beginning of May 2021, more than 300,000 of have been recorded and it may be underestimated. The health system is collapsing and a lack respirators as well as of oxygen in most of the hospital around the country, forced the Indian government to mandate that industrial oxygen be directed toward hospitals for helping patients in respiratory distress. These new cases are believed to be directly related to the new highly contagious variant of the coronavirus: B.1.617.

There are reports that dead bodies in the street, burning on pyres. The United States of America shipped already 60 million of doses promised. India is second to the USA in numbers of death with COVID-19 with 14 million while the USA has 32 million.

Recently, the SARS-CoV-2 spike protein was detected in the urine along with albuminuria probably suggesting that the infection may have reached the kidney or perhaps an error in filtration. There is now an antigen capture assay which has been used at Yale New Haven University hospital and at the Children Hospital in individuals with a positive COVID-19 test   from specimen taken via nasopharyngeal swabs.

The SARS-CoV-2 spike S1 protein was found in the urine of 23 of the adults (25%) but not in the urine of the children. One adult had detectable viral RNA in the urine meaning that the spike protein was not due to the presence of infected cells in the kidney. Another group (24%) displayed high level of albumin and Cystatin C in the urine. The investigators correlated that albuminuria exceeding 3% correlated with the presence of the spike protein. No correlation was found between the virus SARS-CoV-2 spike protein and Cystatin C, creatinine or sex, or body masses or even hospitalization. It may represent an unknown phase of kidney disease spilling the spike S1 protein.

More research is needed. The predominant finding explaining such a kidney injury in the COVID-19 disease, appears to be due probably at the tubular level. Up to half of patient admitted with COVID-19 will get an acute kidney injury. It may represent a sudden case of kidney damage or even a kidney failure happening in hours or days after the hospitalization causing a buildup of waste in your blood and complications like septic shock, clotting problems like DIC or kidney infections. Others may become confused with nausea, and even develop seizures or fall in a coma following the acute tubular injury. They may require dialysis as well.

G-   Cruise ships may resume their activities by mid-July in the USA as announced by the CDC. The vaccinated individuals will be the one allowed to participate. It is believed that the authorities are looking for at least 95% of participants to be vaccinated prior to place a foot on the boat. It will be the equivalent of a COVID passport that the Governor of Florida did not accept when proposed recently in New York. The cruise line will have sixty day to apply for a certificate offering the cruise to the passengers and the CDC will react by giving the authorization in the week to follow. Before boarding the ship, all passenger will take a rapid-response test rather than a polymerase-chain-reaction (PCR) test.

In Florida where most of the cruises originates, the Governor has a stance against requiring to force people to prove they are vaccinated. He is expected to sign soon a bill which will prohibit business, schools and governmental institutions to require proof of COVID-19 vaccination. Actually, as of May 5, 2021, all restrictions on COVID-19 have been reevoked by the governor included the wear of mask in public. The number of COVID-19 cases in Florida has doubled.

H-   It is in our interest to scale up vaccination around the world. The more we do it, the better chances we will have to reach the status of Herd immunity. Everybody need to be cooperative. The virus is also learning about the way to avoid destruction by metamorphosing on us, rendering our attempts at destroying it more and more difficult. The situation presently observed in India can be seen tomorrow in the United States or elsewhere. We need to be vigilant and keep our guards with the wear of masks and the practice of social distancing.

It is ironic when one has to know that India is the bigger producer of vaccines in the world and many are asking when the country will start manufacturing them because of its enormous capabilities to do so.

To conclude on our COVID-19 Column, an interesting finding in a classroom of a Philadelphia suburb school has puzzled the medical world. Eight second grader all in the same class and two fully vaccinated parents have tested positive for the virus SARS-CoV-2 last week. All interested parties have been quarantined while the remaining school remained open. The ventilation system is being studied to explain the reason such phenomenon happens. One on five kids may develop mild symptoms of COVID-19 but generally even infected, they remain asymptomatic. Other individual who may have experienced inflamed lymph nodes after taking the vaccine, may have been already infected by the virus prior to take the mRNA vaccine. Soon the vaccination will reach the adolescent and the one presently participating in college activities, bringing a closer chance for us to reach the herd immunity.

I-     It is known that long-haul COVID-19 patients may develop more problems up to six months after they catch the virus and that 50% may have a risk in dying. They may have a higher rate of stroke or any other mental health issues like depression. They may present with general fatigue, kidney disease, digestive symptoms or a heart condition related to the disease. It is believed that the lingering effects of COVID-19 may reverberate for many years to come. He CDC found out that many patients who suffered with a mild form of COVID-19 were back to their physician’s care in six months from their initial infection. The long-hauler COVID-19 appeared to be African American women over the age of 50.

Recently a physician of Indian heritage, infectious disease specialist took an emergent trip to India while he knew pertinently well that the situation was deplorable with multiple death due to a new strain of the virus. He knew that he was protected because, months prior he has received both shots of the J and J vaccine. Inexplicably, he died of COVID-19. We believe in a certain protection after taking our shot indeed. We will have to find an explanation to this death. It was found out as well that it was frequent to find people in India deficient in Vitamin D.

Maxime Coles MD

Boca Raton FL


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