August 2022 COVID-19 Chronicle

  1. Global vaccine-safety monitoring of adverse reactions following COVID-19 vaccination had started in December 2020 with the first vaccinations. Passive surveillance systems have been placed and data have been collected on doses administered. Also, clinical reports and medical electronic records systems have permitted the evaluation of the COVID-19 vaccination with Myocarditis and pericarditis. We previously discussed the topic especially among elite athletes and the evidence gathered to date supports an association between mRNA COVID-19 vaccination and myocarditis. and pericarditis. The risk appears to be greater for adolescents and young adults’ males after the reception of the second dose of vaccination. Symptoms will start one or two weeks after the dose.
  2. In Ontario, Canada, a surveillance system for the vaccine was set to report myocarditis and pericarditis from people who received different vaccines mRNA 1273, and BNT 162b2 after the administration of two doses. Data including age, sex, dose number and reported pericarditis and myocarditis among male individuals were found higher than in the same female population for an age of 25-39. These data were collected by Buchanan et al. The highest reported rate was observed in individuals aged 18 to 24 following two doses and were consistent with findings from other surveillance programs across many other countries. It appears also that a longer period of time between the two doses of the mRNA CoVID-19 vaccination may be associated with a lower risk of Myocarditis and Pericarditis. It was also found that a heterologous dose of mRNA-1273were associated with the higher reported rates. It appears to be unclear but studies are on-going. Tis vaccination has prevented substantial morbidity and mortality and has been used as the most preventive strategy against COVID-19, also avoiding the infections and its serious complications. Nowadays, younger age groups are receiving the vaccines and its boosters, more vigilance is needed to monitor myocarditis and pericarditis in the population.
  3. The US is facing also the new outbreak of Monkeypox as it has not technically categorized as a sexually transmitted infection (STT) while it looks and acts as such. If in 2020, 25 million sexually transmitted infections were diagnosed among people of every race and sex or sexual orientation as well as all ages. Syphilis has increased among newborns (236%) since 2016 and other STDs like gonorrhea has reach historic heights among teens. HIV remains rampant. The lack of accessible testing is a major factor. More, there is no dedicated federal funding to guarantee Sexually Transmitted Infections resting. Family planning and HIV testing may be available and clinics which provide community education and treatment to the community, have allowed a drop in the rate of HIV infection and has helped to decrease the teen pregnancy rate. Unfortunately, it is not the same for Syphilis, Gonorrhea, Chlamydia or Monkeypox. A coordinate outbreak response may need to be implemented to face the new diseases in order to develop point of cure testing, technology to outreach the public to the technicians. Possible vaccinations may be also needed.
  4. We have learned from the AIDS epidemic and lessons can be applied to the Monkeypox. Clinics as we have already pointed out to provide the same care we are actually offering for gonorrhea, chlamydia, syphilis and other sexually transmitted diseases includes HIV-AIDS. The same kind of clinics can be offered for Monkeypox.
  5. COVID-19 and HIV are simply diseases which have imposed a wake-up call to the government in order to prioritize public healthcare need in pandemic. Congress will need to invest permanently in disease prevention. HIV and COVID-19 are only wake-up calls. The authorities will need to provide communities with infrastructures able to promote health care for everyone. We have seen too much of thr politics mixed in medical debates where one party in power blaming the other for the state of unreadiness.
  6. How to decide on ending your COVID isolation? So often, I hear that one can’t know when to end an isolation period after you tested positive for the virus. You may be feeling better but you are still positive. We may have seen many subvariants but the rules have not changed, isolation will help you stop passing on the virus to others. The CDC is formal in stating that one can stop the isolation after five days once they are free of symptoms like fever but they need to continue wearing the mask to protect others for another week. Others believe that the mask should be worn until the test becomes negative. You may choose to perform a rapid antigen test as well. Unlike a PCR test looking for genetic material from the virus rapid antigen tests work by looking for the proteins packed inside the virus. So, a positive test translates the presence of an infectious virus. It is customary to find that a person infected with the virus but not testing positive for the antigen 10 days later. In doubt, keep wearing your mask.
  7. COVID-19 re-infections can bring serious medical problems necessitating further hospitalization and possible more stay in ICU and deaths due to complications. If the vaccines have provided protection during this pandemic, they have allowed us to be more prepared for re-infections. The risk for long COVID-19 the Omicron subvariants BA.4 and BA.5 is rampant as a Veteran Administration study has recently shown. Medical issues to the lungs and heart are seen a month after the re-infection and remain a risk as long as six months after.
  8. The state of Connecticut has reported its first case of Monkeypox. infection. Any suspected patient suffering from the disease should be isolated and hospitalized in a single person room. Proper wear of gloves, eye protection and mask like a should be in use. N95 If the patient does not require hospitalization, he should be isolated at home, with proper precautions until the lesions have fully resolved. Antiviral medications like Lecovirmal may be recommended in people severely ill. Vaccinia Immune Globulin given via intravenous route, Cidofovir (Vistide) can be also given. Healthcare workers with unprotected exposures, Healthcare workers who did not wear protective gears should be placed under surveillance for symptoms. Any individual with perianal or genital ulcerations, diffuse rashes or proctitis syndrome should be tested as stated by the (STI) guidelines of the CDC because the clinical presentation of Monkeypox may be similar to Syphilis. Herpes, lymphogranuloma venereum etc. A through skin and mucosal examination (oral, vaginal or anal) is mandatory and lesions may be detected when the patient may have been unaware of. Malaise, headache, fever can be also present. If a rash does not appear in the 5 days following these prodromes, it is unlikely that we are dealing with monkeypox.
  9. Recent data (July 2022) in the state of Florida has shown that the COVID-19 Infection and hospitalization rates remain stable at a high-level recording almost 11,000 cases /day and 3500 confirmed COVID-19 cases. The positivity test hit 23%. Recent controversy on the availability of the COVID-19 vaccine to the disadvantaged children has been the source of discussion between healthcare providers and the health authorities in the state of Florida. Total number of COVID-19 cases recorded in Florida since the pandemic around 6,500,000 for a grand total of 76,000. Presently almost 70% 0f the US population is fully vaccinated and only 27% is boosted.

 

Maxime J-M Coles MD
Boca Raton FL

 

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