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September 19th Covid update

Hello everyone!

Here is the latest on covid numbers and research.

Local numbers: Please keep in mind testing positivity is now artificially low because of the availability of home tests (which is a good thing! But people are not calling in their positive results, so numbers are falsely low).

Lake County, IL:

Testing positivity rate is 3%. Percent of Lake County Residents fully vaccinated: 68%. Hospital beds used for covid patients: 11%, ICU beds used for covid patients: 19%

Racine, WI:

Testing positivity rate: 9%, Percent of Racine County residents fully vaccinated: 60%. Hospital beds used for covid patients: 10%, ICU beds used for covid patients: 23%

Kenosha, WI:

Testing positivity rate: 10%, Percent of Kenosha County residents fully vaccinated: 59%. Hospital beds used for covid patients: 12%, ICU beds used for covid patients: 28%

Latest news/ studies:

CDC updated guidelines recommending high grade mask (N95 equivalent) for all individuals due to higher infectivity of delta variant and now resolved PPE shortage. They recommend at least a surgical grade mask (2 or 3 ply and water resistant) as a second line option. They do not recommend cloth masks for protection.

Where did covid start? I’ve personally never cared about the origin of covid, only getting out of this pandemic and back to pre-pandemic living for myself and my family/friends, but I know a lot of people really do care about this: the latest research published (this is a pre-print meaning it is NOT yet peer reviewed) shows the closet animal reservoir to the Sars-cov2 spike protein is in bats from Northern Laos. This suggests the animal to human crossover model is more plausible than the escaped from the lab model. In the battle of lab leak vs natural spillover- this data suggests the theory that the spike protein is humanly engineered to bind hACE2 is much less likely in view of the very close homology of these other coronaviruses from Laos. Super interesting study to read if you like genetics and virology. It will be published in Nature after passing peer review.

New variant: Meet Mu

The Mu variant is highly resistant to the antibodies induced in COVID-19 natural infection (convalescent serum testing) & vaccinated individuals. It is the most resistant variant ever tested. It is in every state now, but mostly in CA and FL. The good news is that is NOT as transmissible as delta - so it is basically being outcompeted by delta nearly everywhere for now. Wake me up from this craziness when we get to Omega.

Blood donation samples through May 2021 suggest 83% seroprevalence of covid in the US. Note this does not mean that 83% of the US population has had covid. Far from it. It means that in blood donors, 83% had at some point been exposed or vaccinated as of May 2021.

Natural immunity vs vaccine immunity: studies suggest the strongest immunity, measured as highest levels of neutralizing antibodies, have been in those naturally infected with covid first and then vaccinated. No governing health body or rational person suggests that you should risk getting natural covid infection first as a strategy to boost immunity but if you by some chance had covid first and then got vaccinated, you are in the upper echelon of immunity as far as we know today. Please get vaccinated before contracting covid due to the risk of death, serious disability, long covid syndrome, lost time from work/life/loved ones ect. The risk to remaining unvaccinated is high and affects more than just you individually.

Vaccine news/studies:

3rd dose booster:

Both Pfizer and Modera submitted data for a booster shot 8 months after the second shot of the series. The data was then reviewed by no less than other 4 regulating bodies and 3 countries (UK, Israel, US all presented population health data and CDC, FDA, an external vaccine regulating review board and ACIP). In other words, lots of independent and non-related scientists trained to review this data reviewed it and put forth their conclusions. I hope that lies to rest any conspiracy theory hopes that the FDA or CDC is somehow directing everything. It would be very hard to do that across multiple countries and governing bodies. In summary, this independent group made the following recommendations:

A 3rd dose is safe. Main side effects were similar to shots 1&2 (fatigue, headache, chills, muscle pain). Israel presented their real world third dose data because they have already boosted much of their population. There was one case of myocarditis out of 1.1 million third doses given. It was a 30-year-old male with mild chest pain and fevers three days after the third dose. He recovered fully without incident.

A 3rd dose is effective. Data released shows a significant increase in neutralizing antibodies. Again, Israel presented their data showing that around 6 months post vaccination, they were again experiencing a significant surge in covid related hospitalizations. They ended up giving the 3rd booster dose and after that rate of severe disease fell again. Israel stated their main decision for a booster approval was two-fold: to reduce transmission (goal of R0 below 1) and to prevent long covid syndrome in the population. They are still gathering data as to whether these goals were met.

Data showed that neutralizing antibodies are good at protecting against infection and spread. B and T cell responses were also strong.

The mRNA vaccines are effective against the delta variant. The data presented showed the increase in cases in vaccinated individuals was a timing issue (i.e., waning of neutralizing antibodies) rather than vaccine ineffectiveness against the variants like delta. (side note, Mu variant IS rather resistant to the vaccines). (second side note, Moderna is already testing a re-formulated vaccine that includes delta and mu variants and it’s going well but the full study will not be done until Sept 2022, but they have given the new formulation to study participants)

Data analyzed could not come up with a threshold for antibody levels needed for protection. We still don’t know if the number is 50 or 200 or 500. It is estimated to be 50 for original covid (alpha) and 200 for delta strain but this is based on educated modeling at this time. Data that does answer this question is due out in another month.

From all the presentations and data review, the answer for now on a third (booster) dose is: YES to certain select groups:

1)to anyone over age 65

2)severely immunocompromised (defined as solid organ transplant recipient or equivalent)

3)certain medical conditions (definitions TBD)

4)certain populations (healthcare – yes, teachers- TBD)

They voted NO to the general population receiving a booster for the following reasons:

1)the data shows the vaccine is still working well though they acknowledged breakthrough infections are happening with increasing frequency due to timing

2)The Pfizer booster dose group was only 300 people. Israel obviously had over a million people given boosters, but the committee decided long term safety data could not be determined until more people receive the dose. Go figure that we need more people to have a booster to fully evaluate safety, but they are not approving a booster for everyone. Once again high-risk groups and populations get a third dose (yay!) at the expense of being guinea pigs for the rest of the world (yay?)

What about the kids?

The last time the independent review committee met on this was 6/10/2021. At that time, they were not uniformly in favor of approving EUA for those under 12. They decided it would not likely be until Nov/Dec 2021 that EUA is approved for children under 12. It is not a decision they are taking lightly and are weighing risks (adverse events) and benefits (risk of severe covid, death, long covid syndrome and MIS-C) in that population as well as supply issues with adult booster doses coming. More to come…

Please if you remember anything else from this email- delta spreads very easily indoors without a mask- especially if unvaccinated.

“The good thing about science is that it's true whether or not you believe in it.” – Neil deGrasse Tyson

Have a happy fall!

Dr. Green

Medlogic Primary Care

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