COVID-19 update: Monday, November 23rd

Friday and some history, AstraZeneca, Remdesivir, NYC and some final Thanksgiving tips.

Happy Monday. I hope you had a restful and relaxing, or at least social media/news free weekend and you are ready to face this holiday week together. Here is the latest news you need to know.

1. Friday wasn't good. Numbers hit new highs for both cases and deaths. While this is very concerning, it is worth remembering that as cases increase deaths will naturally follow. So far, the balance or proportion of cases to deaths is remaining steady - which is good. If you are looking for some historical reading here is a great story on how Thanksgiving looked during the Spanish Flu of 1918 https://www.usatoday.com/in-depth/news/nation/2020/11/21/covid-and-thanksgiving-how-we-celebrated-during-1918-flu-pandemic/6264231002/

2. AstraZeneca has some early results on their vaccine. The news on this one is easy to misunderstand so I want to explain it. AstraZeneca tested out two different dosing regimens, i.e. they tested two different ways of administering the vaccines the vaccine was 90% effective if administered at a half dose and then at a full dose, or 62% effective if administered in two full doses giving it a 70% effectiveness rating overall (when you average the two options together). Obviously, you wouldn't receive both dosing options and if choosing one you would obviously want to pick the 1/2 dose followed in a month by a full dose to get the 90% effectiveness. Why the 1/2 dose to begin with works better is not 100% understood but scientists suspect it is because that better mimics the natural function of the immune system.

Also worth noting, the AstraZeneca vaccine is NOT an mRNA vaccine but an adenovirus vaccine which is a type of vaccine that has been used for decades and is well understood. (it uses a dead cold virus that is genetically altered with part of a dead SARS-COV2 virus).

The AstraZeneca vaccine is also easier to store and transport making it easier and less expensive to distribute and finally, they are promising to provide the vaccine around the world on a not-for-profit basis. On a downside, wealthier nations have already bought billions of future doses of the vaccine leaving poorer nations possibly waiting years to get the vaccine. Remember, the storage and transport requirements of the other vaccines make them unrealistic for poor nations. This is my new favorite option - but of course, we still have a lot to learn about all three vaccines, and most people working the pandemic are waiting with cautious optimism before advocating for any vaccine. We simply don't have quite enough information to weigh in - so stay tuned and rest assured that people all over the world are scrutinizing these. You can read more about the AstraZeneca vaccine here: https://covid19vaccinetrial.co.uk/sites/default/files/covid19vaccinetrial/documents/media/201123_press_release.pdf?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=newsAlerts&utm_term=coronavirus&utm_content=2020-11-23&apid=34913069

3. The WHO has advised against the use of Remdesivir in hospitalized patients. This was done in response to a study that found, "“[r]emdesivir, [h]ydroxychloroquine, [l]opinavir, and [I]nterferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.” You can read more here: http://press.psprings.co.uk/bmj/november/remdesivir.pdf While that is not great news, learning what works and what doesn't is important and baricitinib, an arthritis medication, is moving forward as a possible treatment for hospitalized patients - so there is plenty of hope out there.

4. NYC has announced they will no longer have face to face school in order to reduce the spread of disease. While children are less likely to have severe COVID, teachers and staff are not and children over 10 seem to get and spread COVID the same as others.

5. Instead of more news I thought I would offer some reminder tips for Thanksgiving. I am attaching an infographic with some of these reminders. But if you are opting to gather with family (and I understand that some people need that, particularly those who live alone) hopefully you have been quarantining in preparation. Outdoor meals would be the best option as you gather together. Keep gatherings small, leave as much space as possible between you and others. Clean and disinfect the home where the meal will be held the night before or morning of. Travel by car if possible. Keep the visit short instead of all day. Do outdoor activities as possible.

Hand wash frequently and avoid touching your face as much as you can remember. Get a HEPA filter with a rating of 13 or more and install it at least 24 hours prior. Multiple rounds of filtration help. Take advantage of the free, unlimited Zoom offering for Thanksgiving day. Use disposable cutlery and dishes and serve the food buffet-style instead of passing it around. Obviously, not having people from outside your home would be best - but again, isolation for some has been very difficult and has caused some mental health issues such as depression and anxiety so use wisdom regarding what is best for you and your family.

Thanksgiving.pdf

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FINAL THOUGHTS: There comes a point where you have pushed, pulled, and dragged yourself as far as you possibly can. You reached the end of the rope and you dug deep, deeper still to find some small little ounce of something to keep pushing, pulling, and dragging until eventually, you hit a wall and there is simply nothing left. For me, that was last week and when I hit the wall I hit it hard. Real hard. That isn't always easy to accept but the reality is we do have limits. So as we start a new week - a week of Thanksgiving, listen to your body. Take it easy, be kind to yourself, and spend the week reflecting on all the things we have to be thankful for. If you are having trouble identifying them start small with things like the sound of birds singing, socks to keep your feet warm, and a cup to hold your coffee. But this week feel your bucket with all that we have to be thankful for instead of what we are missing. I will see you back on Wednesday.