2021 COVID-19 Column

A-       Dying for not being able to receive Oxygen was the story in many countries including India and Haiti. This crisis is reaching some African and Asian countries while others are clamming that 40% of their population has been vaccinated.  population. This is what countries like England, Israel and the United States of America would like us to believe.

The COVID-19 outbreak and its variants inter-connect us around the world. We will be all affected, vaccinated or not. Poor countries need the basic to resist against the constant the attack of the virus. Oxygen is lacking although essential. If a country like India can be unable to supply its own citizen with the necessary during this pandemic, one can understand while poorer countries are unable to compete with nations claiming that 40% of their population has received the vaccine.

Nobody in Haiti has received any vaccine unless you were fortunate to have a recent trip in the United States or at least Medi share has started to vaccinate its personal and we have the promises from the American White House that a stock of Astra-Zeneca Vaccine will be given to the government of Haiti for the population. We registered the way, last month, it seems that vaccines were sold on the black market and one was paying up to 40 US dollars to receive a dose.

People already can’t pay for oxygen nor they can pay for cremation. In India, so many have died and they disposed the bodies in the rivers. Surplus of vaccines need to be directed to the poor countries, not only in India and Africa but also toward the Caribbean countries.

Hospitals are in a desperate need for supply to fight COOVID-19. The WHO states that countries like Ethiopia and South Africa have at least a 5% rate of positive cases in their population. Today they just announced that they will use Greek letter to name the new strain like the England strain will be called “Alpha” other Beta, Gamma etc I do not know if this will make a difference especially that we are already using the present determination to name them by their place of origin. So, the strain B. 1. 167 from South Africa will become as well the strain “Beta” etc.  The Indian strain is now seen in South Africa and the name of Kappa was given to it.

All of the strains are already highly transmissible. It is possible that the catastrophic situation seen in India now may be as well observed in Africa in a near future. These poorest countries have already a very low COVID-19 vaccination rate (less than 1%) so the notion of Hurd Immunity will not be achieved in Africa or in many of the poor countries around the world. The more powerful nations will realize soon that we are all in the same battle and they will need to come in aid to these nations not able to vaccinate or protect their population against the pandemic. This is why we are starting seeing the United States offering help to different nations around the globe. 

B-        The world is interconnected through global travels and the COVID-19 crisis the way we have witnessed in India, will happen in other countries. Haiti is now a battlefield and without any vaccine the population will be unable to fight. Much needed Oxygen was also appreciated because people did not have enough money to be able to afford some. Many countries will develop field hospital and will be in the need to practice by telemedicine capabilities.

We may need an association with the private membership to render these facilities functional enabling them to track down the variants through testing. India has seen more than 250,000 of deaths and in a little time more than 23 million of infected COVID-19 cases.

In the meantime, the US surpasses 600,000 Covid-19 deaths while the infection rate has shown a decline. Many countries are attempting to return to a pre-pandemic normal life. The more people get vaccinated the more there is a decline in the number of severe illness but hundreds of people are still dying every day. Worldwide, more than 176 million people are known to have been infected with the coronavirus while 3.8 million have lost their life. The virus is still metamorphosing and presenting more strains which represent a threat for the unvaccinated.

The vaccination has slowed down in the United States after its pick during the month of April when an average of 2.3 million of vaccines were administered dropping to a 1.8 million in the month of May, so a drop of 46% in the rate of vaccination. Racial and ethnic disparities persist with poor access to a vaccine. Many states across the country have stopped sending request for vaccines to the federal government while their doses in storage will expire by the beginning of July. Despite the drop in the demand, vaccination around the country seems to be paying off to a point that new cases of COVID dropped to below 10,000.

C-        The CDC reported that almost 5 million COVID-19 cases can be found in 55 countries in Africa. The variant B.1.167 which was recently a concern in India, is now reported in Africa. Positive tests are increasing in South African countries and in Ethiopia. Hospitals are desperate for Oxygen and the world will need to bring more help to this continent because the rate of vaccination is less than 5%.

Meanwhile researchers have discovered at my surprise, in 2018 an unknown kind of coronavirus in a child which demonstrated signs of pneumonia in Sarawak Malaysia. It may have represented the first contamination of a coronavirus spread from a dog.to a human. This canine coronavirus was called CCoV-HuPu-2018 and was found different from the actual virus that caused COVID-19 (SARS-CoV-2). It is apparently the 8th known coronavirus capable to cause am infection in humans. It does not appear to be of any threat to humans and there is no truth either that can be transmitted from person to person.

Gregory Gray MD, an epidemiologist at Duke University has already asked the question to see it another coronavirus may have already threatened humans around the world. Unfortunately, the Coronavirus test we have actually can look for only the SARS-CoV-2 virus. 8 cases were found in these Malaysian children population and all of them recovered well. They also hypothesized on how the virus can affect humans in order to make sure that we can be ready for the next possible outbreak. The dog interaction with the humans is being studied as a wake-up call. They found out that the CCoV-HuPu-2018 was able to spread to humans because of a deletion or a change in its genome from the human version, similarly to what happened in the SARS and SARS-CoV-2.

A-       Researchers also reported a first case of COVID-19 causing recurrent blood clots in a patient forearm. We knew of blood clots in patients with COVID-19 in the lower extremities but a new case of clots in the upper extremity has been discovered in an 85-year-old man who has also prior history of blood clots in the upper extremity. It was reported in an article published in Viruses, discussing the findings of scientists at Rutgers University.

It looks like the patient presented with complaints of swelling to the left arm and was diagnosed with a blood clot. He was known to be an asymptomatic patient with COVID-19. He had no respiratory symptoms but needed a hospitalization for treatment of the blood clot. Most previous blood clots were found to the lower extremities. Only 10% of the blood clots were discovered in the upper extremity Swelling and pain as well as arm fatigue with embolization to the lungs can represent an important complication. Healthcare providers are encouraged to perform more doppler testing in such patients with unexplained swelling, shortness of breath or low oxygen levels. At risk will be the one predisposed to blood clots.

Shortening of breath and peripheral edema have been recorded among individuals who have received a second dose of vaccine and some even suggest a possible pericarditis and a need for a pericardial biopsy when a pericardial effusion was discovered. This has been seen with the Pfizer vaccine in a 56-year-old female 70 days after receiving her vaccine It was debated that she was asymptomatic while the effusion was detected. The patient was positive for IgM for SARS-CoV-2 but negative for IgG. How to conclude? We may know better in the future.

If one present with fever, dry cough or shortening of breath, he/she should get tested for the Coronavirus in clinics or hospitals or with home kits allowing you to collect the sample and send them to the lab. Most people may recover without knowing if they have ever tested positive for the virus. The more you rest the faster you will recover away from others. Drink a lot of fluids to avoid dehydration but if the symptoms get worse, look for medical help.

We mentioned above that the Delta strain, the more deadly of COVID-19 strain, originated from India, is now surfacing in the United Kingdom. And we should expect it to reach the United States of America probably soon. The previously called the variant B.1.1.7 strain originated in the United Kingdom remains the dominant strain in the USA but 6% of the US population have already seen the Delta stain. That strain is now in more than 60 countries and the transmissibility appears to be at its maximum. Delta strain is also seen in the age group of 12-20. People are still protected from it with the vaccine and this should encourage the public to get vaccinated.

300 million COVID-19 vaccines have been administered. 15 states and the District of Columbia have more than 70% of their population vaccinated. According to the CDC, more than 316 million doses have been administered. The data let anybody know that if you are unvaccinated, you are at risk of catching the virus of SARS-CoV-2. Recently a Texas worker who declined to take the vaccine, become ill with COVID-19 and he required later a double lung transplant for him to survive,

The CDC reported 300 cases of heart inflammation in young people after COVID-19. Rare cases of myocarditis linked with Pfizer and Moderna vaccines. Patients with such symptoms should be reported especially when they demonstrate fever fatigue, chest pain and occasionally shortness of breath. Those symptoms are expected to resolve. 

More than 350 medical workers in Indonesia who have received a Chinese made COVID-19 vaccine have tested positive for the virus although asymptomatic. A handful of those worker were hospitalized because of high fever. More than 1.9 million of infections and 53,000 deaths were recorded while at lease 950 doctors died during the pandemic. This week, John Hopkins announced that there are more than 177,6 million case and more than 3.85 million deaths worldwide. In the United States there are more than 33.5 million cases of COVID-19 and more than 601.200 deaths.

Maxime Coles MD

Boca Raton FL

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