Home COVID-19 Friday Night Update from the ER in Arlington, VA: New Bivalent Vaccines...

Friday Night Update from the ER in Arlington, VA: New Bivalent Vaccines Approved; “Our 6-week percent positive running average has been 29% and this past week it was about 19%.”

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Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency Medicine at the Virginia Hospital Center in Arlington, for these superb updates!

Although we diagnosed about twice as many cases of COVID on Wednesday compared to a typical day, overall, the numbers of new COVID cases we diagnosed this week declined. In fact, among our symptomatic patient population, the numbers were the lowest they have been since late April. Our 6-week percent positive running average has been 29% and this past week it was about 19%. Among all of our patients, which includes our asymptomatic patient population, the percent positive rate declined from a 6-week running average of 12.5% to about 11% and represents the lowest amount of positive cases we’ve seen since mid-June. Both the number of patients who required “covid isolation” and the number of people currently hospitalized also declined compared to last week.

COVID is such a bizarre illness. A 40-year-old who is healthy may get admitted to the hospital for low oxygen levels. Meanwhile I took care of a patient well into their 90s this week who was on day 5 of COVID symptoms, was pretty stable, and was able to be sent home. In a typical influenza winter, I do not recall ever having to admit a previously healthy young to middle-aged adult for complications of influenza, whereas we routinely admitted elderly patients.

The new vaccine approval happened fast. Over the past week, the FDA first approved the bivalent vaccines developed by Pfizer and Moderna. From there, approval moved to the CDC who voted 13-1 to approve. Finally, CDC director Dr. Walensky signed off on the new vaccines. Both Pfizer and Moderna have developed mRNA bivalent vaccines. These are vaccines that contain the original version of COVID as well as a new version designed to elicit an immune response for the BA.4 and the BA.5 sub variants. The Pfizer booster is approved for those over the age of 12 and the Moderna vaccine is approved for those over the age of 18. Vaccines are being shipped over the weekend and may be available in the next few days.

As exciting as this is, there are definitely some questions among experts as to how much additional protection this new formulation will offer. While an earlier version of the bivalent vaccine was tested in humans, in order to get this newest formulation in the arms quickly, we do not have human data. Scientists have seen an increase in neutralizing antibodies in mice. This should not necessarily alarm people. Probably most people do not know that the flu vaccine formula that is customized each year is also tested only in mice. What we do know is that over the last couple of years, people that have received boosters are less likely to get critically ill and die. We also know that the immunity seems to wane over time. Finally, there is strong consensus that the technology and the vaccine are safe and will not cause any harm. As with all of these vaccinations, if you have any questions, you should discuss them with your doctor. I do anticipate getting my dose of this vaccine in the near future.

There have been several recent reports looking at the impact of COVID from a broader perspective. First, the CDC estimated that there were 238,000 excess deaths that occurred from causes other than COVID since the start of the pandemic. The CDC also released a report on life expectancy. Compared to 2019, 2020 showed that “life expectancy at birth in the US dropped by 1.8 years, the biggest yearly decreases World War II. This trend continued in 2021 as younger adults suffered worse outcomes from COVID-19 with a net loss of life expectancy now exceeding 2 years.” This was the first time in more than 100 years that the life expectancy in the US has fallen 2 years in a row. In 2019, life expectancy was 79 years. In 2021, that number is now 76.1 years. Some of this is obviously related to the large number of deaths from COVID. However, we have also seen an increase in substance abuse and mental health disorders, which contributes by having increased amounts of people die by overdose and suicide. Unintentional injuries also increased in 2021 and this is largely a result of drug overdose deaths. There has also been an increase in chronic liver disease and cirrhosis, related to an increase in alcohol use. The pandemic also highlighted health disparities among populations. The largest impact on life expectancy has been among the Native Americans and Alaska natives. Black and Hispanic Americans also saw large declines in life expectancy, whereas Asian Americans had the smallest decline in life expectancy over the last 2 years.

A new study from the Journal of Pediatrics found a significant increase in the number of children being diagnosed with type 2 diabetes during the pandemic. This is particularly prominent in the Black and Hispanic communities. Although I’ve seen some reports trying to link COVID as a direct cause of developing pediatric diabetes, these authors suggest that the lockdown may have contributed as children were removed from normal day-to-day activities such as going to school, playing sports, etc. When schools were closed and/or during lockdown, children spent more time at home watching TV or playing video games (definitely true with my son). The authors compared two years prior to the pandemic to the first 12 months of the pandemic (March 2020 through February 2021) in 8-21-year-olds, and found a 77% increase in the amount of new diagnoses per year. The analysis also showed that more boys were diagnosed with type 2 diabetes than girls during the pandemic, which was a reversal compared to pre-pandemic rates.

It took 2 ½ years but N95’s are no longer considered in short supply. This is due to a few things, including reduced demand, improvements in the supply chain, and the approval of new disposable N95s. I’m generally not in an N95 at work anymore. Before each shift, I grab a new N95 and face shield and take them to my workstation. I’ll put them on if I’m going into a high-risk environment, so I’m generally wearing them for at least 1-2 patients, but I’m happy to throw it out at the end of the night.

Coronavirus is not done with us yet.

Science matters. Get vaccinated (or your booster). Keep a mask handy.

Mike

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