02Apr21 Covid Update

“We hugged our preschool grandkids for the first time in a

year this week, as our 14 days of post-vaccine waiting time was
completed. We ate pizza, played hide and seek, competed in
Candyland and watched a couple of episodes of “Bluey” with
them. It was the best time ever. — Mary Jo Asmus, Kalamazoo, Mich.
NY Times 28Mar21

Local Update
Numbers are up again with some tests coming back as invalid or possible di erent
strain. The mutant strain(s) is/are here, like it or not. Cases are going up again.

Cases seem to a ect the younger population that are not yet vaccinated.

SVH has 11 cases of Covid and none in critical care

Epidemiological Update
Cases in the US and throughout the world have been ticking upward, a concerning
trend. The 3rd surge is already well on the way in a large part of Europe, some in Asia
and Africa. The only reason why we do not have a surge right now is due to our
vaccination e ort, 150 million and counting…It’s also clear the the variant is here, since
we can see that cases are becoming more contagious than before with higher attack
rate among those non-immunized.

My advice: remain vigilant with patient care, but take advantage of your immunized
status and open up your social life, and encourage everyone to get vaccinated to
tamper this uptick of cases. All children<16 are not yet vaccinated.

Some universities started requiring all students to be fully vaccinated before going
back to campus this fall.

UK’s one-shot strategy for the 2-shot series is working out so far with rate of new
infection plummeting despite the UK strain wreaking havoc on the rest of Europe. NY
Times 19Mar21. Too late for US to change strategy now, too confusing. Plenty of
protection after one shot for all main 3 circulating vaccines out there (P zer, mRNA,
and AstraZeneca).

CDC said that elementary schools need the be kept only 3ft apart when wearing
masks, versus 6ft previously

Covid antibodies present in 20% of donated blood from unvaccinated people to

American Red Cross. CNN Health 21Mar21; the 3.3 million samples were collected
from June 2020 to Mar 2021.

There are cases of fully vaccinated people getting infected, but the number is quite
small. NY Times 23Mar21. One small study from Dallas found 4/8121 people getting
infected, and another in Southern CA found 7/14,990 of those fully vaccinated with
P zer vaccine getting infected.

MGH study in 131 pregnant/lactating women receiving mRNA vaccines found that the
vaccine confers passive immunity to fetuses and newborns via placenta and breast
milk. Harvard Gazette, 28Mar21

fi
ff

ff

fi
ff

 Recent study found pandemic weight gain average about 1.5lb/month for 7,444
participants. Pandemic stress creates pandemic weight gain, no surprise.

The CDC has published some risk assessments by age. Being a child aged 5 to 17 is
99.9 percent protective against the risk of death and 98 percent protective against
hospitalization. For children 0 to 4, these numbers are 99.9 percent (death) and 96
percent (hospitalization). Unvaccinated young children have almost the same low risk
of Covid death and hospitalization as vaccinated adults. The Atlantic 21Mar21. The
author recommended going ahead with making summer vacation plans even before
kids are being vaccinated.

Clear Face Masks improved communication by surgeons as perceived by the patients;

JAMA Surg 21Mar21; surgeons also scored higher on empathy and trust by the
patients.

Covid
TNF-alpha inhibitor leads to blunted antibody response to Covid infection compared
with Vedolizumab (another Biologics); Gut Mar ’21; Seroconversion in In iximab (TNF-
alpha) found to be 48% compared with 83% in Vedolizumab in con rmed Covid
infection.

One in 2 individuals reports new symptoms 4 months after Covid hospitalization; JAMA
17Mar21. Most common symptoms are fatigue (31%), cognitive symptoms (21%), and
dyspnea (16%). Among the ICU patients, anxiety, depression, and PTSD were
reported by 23%, 18%, and 7% respectively.

Lack of sleep, severe sleep problems (trouble falling asleep, frequent awakenings,
sleep aids >3 times/wk), and high levels of burnout all increase risk of Covid infection.
BMJ Nutr Prev Health 22Mar21

CRP response following corticosteroids may predict Covid mortality. J Hosp Med
22Mar21. Among Covid inpatients treated with steroids, those whose CRP dropped by
>50% within 72h after treatment (CRP responders) had substantially reduced risk of in-
hospital mortality. Study of 2707 patients. Odd Ratio: 0.27, which is statistically
signi cant.

PCOS linked to higher risk of Covid infection, independent of obesity. Eur J Endoc.
20Mar21

Some patients reported improvement of Covid Long symptoms after the vaccine.
Washington Post 18Mar21. In a survey of 444 patients, 40% reported improvement
after the vaccine, 45% reported the same and 15% reported feeling worse after the
vaccine.

Hospitalized patients with COVID-19 were diagnosed with major cardiovascular events,
chronic liver disease, chronic kidney disease, and diabetes after being discharged from
the hospital more frequently than a matched cohort, reported Amitava Banerjee, DPhil,
of University College London, and colleagues. Infect Disease 31Mar21

Not surprisingly, patients with acute COVID-19 who were discharged from the hospital
had nearly four times greater rates of hospital readmission, and nearly eight times
greater rates of death than the matched control group, with signi cantly raised rates of
respiratory disease and cardiovascular disease

Treatment
fi
fi
fi
fl
 Aspirin use may decrease ventilation, ICU admission, and death in Covid patients.
EurekAlert 17Mar21. George Washington University studied 400 admitted patients and
found Aspirin reduced risk of mechanical ventilation by 44%, ICU admission by 43%,
and in hospital mortality by 47%

Plasma not reducing mortality rate in severe Covid patients. NEJM study by
Simonovich et al. Double blind RCT failed to show 30d survival bene t.

Lower Vit D level increases risk of Covid infection for Blacks, but not Whites. 24Mar21.
Cuto level is 40 or above to reduce risk in the Black population. Authors
recommendation checking Vit D level in the Black population to mitigate Covid risk

Addition of SC Progesterone my represent a safe and e ective approach for treatment
of hyperemic men with moderate to severe Covid-19. Chest 24Mar21. Treated
patients had shorter hospital LOS, less supplemental oxygen, and fewer days of fever.

P zer is developing an oral drug to combat Covid 19. It is a protease inhibitor like that
used e ectively against Hepatitis C and HIV; this works by preventing viral replication
inside human cells.

BI-Deaconess established the Critical Illness and Covid-19 survivorship program to

provide comprehensive care for Covid Long patients. Majority of patients are between
the ages 30-60, reporting breathing discomfort, muscle weakness, palpitations,
dizziness, memory and cognitive impairment, depression, anxiety, and PTSD
symptoms several months after having Covid-19. This is the rst in the country,
starting with screening for impairment, then developing individualized plan for patients
based on their main de ciencies, then arranging for care from a core team of
specialists from Neurology, psychiatry, geriatrics, sleep medicine, PT, OT, and
pulmonary disciplines. BI Lahey Health 22Mar21

A 3rd Monoclonal Abx treatment (Bam/Ete combo and Regeneron are the rst 2) by
GSK was submitted to FDA for approval. Patients 12 yo and older with mild/moderate
Covid illness and high risk for progression to severe Covid are eligible. GSK 30Mar21.
This drug VIR-7831 was found to reduced Covid hospitalization or death by 85%; trial
had to be stopped early due to “profound e cacy”

Dept of Health and Human Services stopped the distribution of Bam for Covid
treatment due to increased resistance to Bam from the variants. However the Bam/
Etesevimab combo and Regeneron products are still recommended for treatment.
DHHS 29Mar21

Vaccine

P zer vaccine demonstrated 100% e cacy against symptomatic disease in
adolescents ages 12-16. ID 31Mar21. Trial of 2,260; 18 cases of Covid in placebo
group, and none in the vaccinated group. P zer will submit to FDA for approval.
France and other EU countries resumed the use of Astra Zeneca vaccine

Astra Zeneca vaccine fails to protect against the S African variant. NEJM 18Mar21.
Study of 2026 subjects in S Africa found e cacy of only 10.4% for this particular
variant.

fi
fi
ff
ff
fi
ffi
ffi
fi
ffi
ff
fi
fi
fi
 B.1.526 SARS-CoV-2 variants identi ed in New York City are neutralized by vaccine-
elicited and therapeutic monoclonal antibodies. BioRxiv 24Mar2, NEJM 16Mar21. This
is the NY variant and the monoclonal antibodies were derived from the Regeneron
combination therapy

mRNA vaccination boosts cross-variant neutralizing antibodies elicited by SARS-CoV-2

infection. Science 25Mar21. Previously infected patients, once vaccinated, have much
improved responses against all Covid variants.

Latest AZ vaccine data (revised on 25Mar21): 75% e cacy, 100% e cacy against
severe Covid illness, and 85% e cacy against symptomatic Covid patients >65 or
older.

The Centers for Disease Control and Prevention tracked nearly 4,000 people at high
risk for infection for three months after they were vaccinated. The researchers found
that a two-dose regimen of the vaccines prevented 90 percent of infections two weeks
after the second shot, and one dose prevented 80 percent of infections after two
weeks

The report also suggested that because it was rare for vaccinated people become
infected, it was likely rare for them to transmit the virus. It also demonstrated that the
vaccines o ered powerful protection against the variants. NY Times 29Mar21

NY became the rst state to create a digital passport for Covid-19. NY Times
29Mar21. The free online platform, called Excelsior Pass, was developed with IBM and
works like a mobile airline boarding pass. Users are assigned a digital pass with a
secure QR code, which they can print out or save to their smartphones. Participating
businesses then use a companion app to scan the customer’s QR code and verify their
Covid status

mRNA vaccine found to also reduce asymptomatic infection by 80%. Clin Infect Dis
30Mar21. The vaccine e cacy that was published from previous trials were for
symptomatic infections only.

Extending interval of mRNA vaccine could be risky in older patients; medRxiv 28Mar21.
Study of patients of median age of 82 found much lower antibody titer compared to a
younger population after one dose of vaccine.

ff
fi
ffi
ffi
fi
ffi
ffi