COVID-19 Update: Monday, January 4th 2021

An update on the mutations. (UK, SA, Denmark) and where we stand with vaccines. (UPDATED to correct the total number of people vaccinated- previously included a typo, and to provide a link to the CDC guidance for who should NOT get the vaccine)

Welcome back. I hope you had a wonderful holiday season and have remained healthy. We have some important news to cover. There is quite a bit here and some of it isn't great so you may want to do a mental health check before proceeding.

1. The UK strain is in the US. A few things to note about the UK strain, it is much more transmissible, by some estimates up to 70% more transmissible. Meaning people who get it will spread it much easier than the "normal" strain. Essentially we would expect every infected person to spread it to one more person than they would have with the prior version. Also, and this is a BIG also - it seems to impact younger people more than the "normal" strain. Younger being those 20 and under. So that is something to be very mindful of. The good news is that so far, we have zero indication that it is more lethal. So it probably won't make us any sicker - however, with it spreading more easily it means we will see more hospitalizations. (it is just a matter of numbers, it more people get COVID then more people will end up in the hospital). We don't yet know if the vaccine will work against this strain but the current belief is that it will, based on the mutations.

2. There is also a new strain in South Africa (SA). Most scientists are more concerned about the SA variant than the UK one in regards to the vaccine. Additionally, the SA variant increases the viral load in the body - which can potentially increase how easily it is spread and possibly how sick you get. We don't know for sure if it does increase how sick you get, but the potential is there and is being studied closely. This is something to be aware of and watch.

3. The Denmark variant (remember the one that transmitted from the mink?) does seem to reduce the length of immunity.

4. The CDC is working on screening for these variants (as are nations around the world). And researchers around the world are studying the mutations’ effects on reinfection, vaccination, diagnostic testing, infection severity, and transmissibility. Currently, there is NO evidence that any of these variants cause more severe illness, or would cause the vaccines not to work. Assessments by national scientific teams to observe the mutations’ effects on reinfection, vaccination, diagnostic testing, infection severity, and transmissibility are all ongoing. You can read the WHO report on the variants here: https://www.who.int/csr/don/31-december-2020-sars-cov2-variants/en/

5. In case you are still trying to conceptualize what is happening in LA county. A quick take on how the virus is accelerating there: number of cases between Jan. 26, 2020, and Nov. 30, 2020. = 400,000. –Number of cases between Dec. 1, 2020, and Jan. 2, 2021, = 400,000.

6. Roughly 4.2 million people in the US have had their first vaccine shot. Remember you are not immune at that point. You don't develop immunity until some time after the second shot, how long depends on which vaccine you get. It is not at all shocking that we are behind the "goal" for vaccinating. This is not because of vaccine hesitancy, but instead due to capacity. Keep in mind our medical system is stretched pretty thin already. Vaccination is one more task on a group that is nearly at capacity in some areas. In addition, the storage and transportation issues along with distribution and infrastructure issues account for the delay. This is just going to take time. Expect to need to wear a mask and socially distance through the remainder of the school year.

7. The AstraZeneca vaccine is rolling out in the UK today which is excellent news. The AZ vaccine requires two doses but does not have the same storage requirements as the Pfizer and Moderna ones making the logistics of distribution simpler. It is also not a mRNA vaccine for those nervous about that. (I originally reported it was a single dose as that was the original plan by AZ - but in clinical trials, they found two were more effective and adjusted the dosing accordingly.)

8. The UK is considering delaying the administration of the second doses of the Pfizer vaccine up to 3 months instead of the recommended 21 days. Some scientists have expressed concerns about this. They believe this could create a situation in which people think they are immune but aren't resulting in unnecessary risk-taking and will potentially allow the virus to develop resistance to the vaccine. These reflect concerns only, there is no evidence to date that either will occur.

9. In the US, the FDA is reviewing a request to administer two 1/2 doses of the Moderna vaccine instead of the regular dose. There is some evidence that two 1/2 doses are as effective as the full doses. The FDA is reviewing the data and will make a ruling. Switching to 1/2 doses would mean we could vaccinate twice as many people with the same amount of vaccine.

10. The goal post for herd immunity seems to be moving....but is it? I cannot explain what has been said in the media regarding herd immunity. I can only attempt to explain a few milestone moments. If you have been with me from the beginning you may recall that very early on I told you that herd immunity would most likely require immunity/vaccination rates in the 80% range. The media kept saying 60% but I could not for the life of me figure out where that number was coming from. I expressed this publically and one of you actually shared the calculation with me that was being used. It is a valid calculation but one that is very simplified and preliminary. Not one that should ever have been considered the final number, more of a starting point. You may also recall that we discussed that that was a very unrealistic number. Frankly, there aren't really herd immunity levels that low. Most start at 75% and range upwards to 95% (depending on the disease and vaccine). I hope you have been paying attention to that as we discussed it so you weren't shocked when Fauci recently mentioned numbers in the 80% range. The precise number will fluctuate a bit as we fine-tune it, but anticipate that we will need at least an 80% vaccination rate to reach herd immunity.

11. This one is just advice, but please please remember that the Pfizer and Moderna vaccines should be administered in a medical setting where emergency medical care can be provided in the event of a severe allergic reaction. While these reactions are not the norm, they are possible in some individuals and require immediate medical care. You should not be getting the vaccine in an environment that is not equipped to provide that care should it be needed.

12. The CDC has updated the list of people who should NOT be vaccinated. The focus is primarily on those with a history of severe allergic reactions - You can find more info here: https://www.medpagetoday.com/infectiousdisease/covid19/90501?xid=nl_covidupdate_2021-01-04&eun=g1689689d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyUpdate_010421&utm_term=NL_Gen_Int_Daily_News_Update

13. In unrelated to COVID news, but relevant all the same, a Bubonic plague outbreak is happening in the Democratic Republic of the Congo. They have seen over 300 cases since August, primarily among adolescents.

FINAL THOUGHTS: We are just a few days into a fresh new year and I hope you are feeling a little refreshed, renewed, and full of hope. If you made resolutions this year I hope they were for things like adding in more adventure or developing new hobbies. 2020 is behind us, but that doesn't mean all the woes of the year have disappeared. We aren't out of the woods yet which can be discouraging. The thing is, we have learned so much about how to manage COVID and how to keep living while we do. So as we head into a new year, find the promise and the hope. Be a spark of hope and joy. I am happy to be with you on this wild ride.