Wednesday, July 28, 2021

Do I need to wear a mask (AGAIN!)?

The headlines this morning were all about the CDC changing its guidelines about whether vaccinated people need to wear masks. In typically nuanced language, they tried to differentiate between those living in areas with high spread and low vaccination rates and those in areas with fewer cases and better vaccination uptake.

What should YOU do?

A few facts:

The Delta variant is now dominant. Nationally, over 80% of strains tested are Delta. Even in Massachusetts, which has one of the highest vaccination rates and lowest cases/population in the country, Delta now makes up over 50% of Covid cases.

Delta is not more deadly – hospitalizations and deaths from Delta are similar to those caused by the original strain.

Delta IS much more contagious. People infected with the Delta variant carry many more virus particles in their nose and upper airway, and thus are much more likely to transmit the virus to others. This is why case counts are rapidly rising in almost every state.

The m-RNA vaccines, in particular, are very good at protecting you from getting infected and even better at preventing serious illness and death from Delta, but they are not 100%. Even if you are vaccinated, you can catch COVID-19 and pass the virus to others.

So, my advice is:

Avoid travel to Florida and other hotbeds for now until they get their act together.

If you live in a state with low vaccination rates, I would wear a mask any time you are indoors with people you do not know are vaccinated and outdoors when you will be in crowds.

If you live in New England or another region with high vaccination rates, it gets more complicated. Life is never risk-free. Every time you get in a car, you are accepting some risk. At the same time, you do common sense things to lower the risk: you wear a seatbelt and you obey traffic laws.

What seems sensible is to wear a mask when you are indoors in crowded spaces: theatres, grocery stores, houses of worship. I would also wear one outdoors if it is a very crowded space where people are always close such as parades and stadiums. This will both reduce your risk and the risk that you could pick up a mild infection but pass the virus to others. It is thus particularly important if you have friends or relatives with poor immune systems.

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Saturday, July 17, 2021

Delta dawns

The news media have been filled with stories about the delta variant of the coronavirus, some factual, some scary. What do you need to know?

First, it is a fact of life that many viruses constantly mutate. That is why you get a flu vaccine every fall: not because your immunity from last year has faded, but because the expected influenza virus will be different than the one that circulated last season. Some of the changes in the virus’ genes make them more dangerous to humans, some less. Some mutations make them less easily transmitted, some more. If a variant is more infectious and/or more easily transmitted from one person to another, it eventually becomes the dominant strain.

This appears to be happening in the U.S. with the delta variant. Luckily it does not seem to be more lethal than earlier strains, but it is more easily spread, and is rapidly becoming the most common form of the virus. Along with the appearance of the delta variant, we are seeing a recrudescence of COVID-19 infections. The lifting of restrictions and decreased mask use is almost certainly also playing a role.

I track the virus in Massachusetts and a month ago our average of new cases was down to 57 a day, and the percentage of Covid tests that were positive had fallen to 0.3%. This week, we are seeing 250 new cases daily and 1% of tests are coming back positive.

This is true across the country. The head of the CDC noted on July 16 that the number of new cases had risen 70% from the prior week. Along with rising cases, hospital admissions had gone up 36% and deaths 26%.

The natural immunity acquired after a mild case of COVID-19 does not seem nearly as effective against the delta variant as it is against to original virus strain. The good new is that the available vaccines do seem very effective, and if you are fully vaccinated, you are extremely unlikely to get seriously ill or die.

Virtually all the recent hospitalizations and deaths have been in unvaccinated people.

While being unvaccinated is clearly dangerous to those individuals, it is also dangerous to others. People who get infected are the source of new variants, and the unvaccinated serve as incubators to produce potentially more lethal variants. Lambda anyone? This new variant now rampant in South America is less susceptible to current vaccines.

If you have not been, PLEASE get vaccinated, for your sake and for ours.

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Monday, July 5, 2021

Vaccines and the Heart

There has been considerable discussion in the media and medical journals about possible heart damage in young males who received the m-RNA vaccines against COVID-19. While we do not yet know enough to make absolute pronouncements, we are learning quite a bit and can make some informed decisions.

Some facts:

1.Myocarditis, inflammation of the heart, occurs from many causes, including COVID-19 infection itself. Some 1% of athletes who had mild COVID infections had evidence of heart inflammation when carefully studied, though most of them had no symptoms.

2.The “normal” occurrence of myocarditis in the U.S is about 10 cases/100,000 people/year. Based on studies in Israel and the U.S. military, the incidence in young adults receiving 2 doses of the Pfizer or Moderna vaccines was several times higher than would be expected, albeit still rare. In the U.S. military, 23 cases were reported after 2.8 million does had been given. The CDC reported 196 cases among young adults, 16-24, when 27,000,000 vaccine doses had been given to this age group.

3.To date, most of the reported cases have occurred in adolescent or young adult males and almost all were soon (less than a week) after the second dose of vaccine.

4.Symptoms included chest pain, and most had some combination of elevated enzymes showing heart muscle damage, minor ECG abnormalities and abnormal heart scans. Virtually all the reported patients had mild illness, with good recovery in about 4 days with a variety of treatments or with no treatment.

The Advisory Committee on Immunization Practice has strongly advocated that the vaccines’ benefits for adolescent males exceed their risk, and this is probably true. The benefits of vaccination do outweigh the risk, even in this select group, but how vaccination is done can take the myocarditis risk into account.

One could argue that healthy young males might prefer to receive the J&J one-shot vaccine, in which this condition has not been reported. I would also argue that young males who have recovered from COVID-19 could be considered safely immune after a single rather than both doses of the m-RNA vaccine and thus avoid the second dose that seems to be the trigger.

Stay tuned. I am sure we will learn more.

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