Frequently Asked Questions about COVID-19 — August 25, 2021

  “Shared expectations lead to predictability.”

346. Booster shots for all after 8 months creates a moral dilemma for the U.S.

         Q:  Isn’t the CDC proposal to give everyone booster shots in violation of WHO guidelines? 

         A:   Breakthrough cases of Covid remain extremely rare.  And even more rare are the breakthrough cases that result in serious disease, as many are asymptomatic, and nearly all the rest result in very mild symptoms.  But the extensive news coverage has raised public anxiety and demands for answers.  The CDC recently announced a third booster shot will help those with an immunologic condition (organ transplants, cancer, and other medical impairments) to increase their protection.  Citing studies that show the vaccines currently approved in the US have waning effectiveness after 8 months, the CDC then recently announced plans to provide booster shots to everyone who is already fully vaccinated 8 months after their last shot.

This has created an international outcry.  The U.S. had promised to donate millions of doses to the international COVAX program for worldwide distribution to poorer countries that need them.  The World Health Organization has spoken strongly that the need is for vaccinations to be distributed widely to reduce the chance of new variants emerging. (The Delta variant now ravaging the U.S. first emerged in India.)  The broad booster shots program here to reduce the slight risk of worsening breakout cases is seen as denying the populations of other countries any protection at all.  “We’re planning to hand out extra life jackets to people who already have life jackets while we’re leaving other people to drown without a single life jacket,” Dr. Michael Ryan, executive director of the World Health Organization’s Emergencies Programme, told reporters last Wednesday.  U.S. officials stated they would increase production to meet both needs.  But in reply, it was stated that even then, poor countries will have to wait until 2023 for everyone to be vaccinated.

347. National aid to Mississippi establishes a two-tiered mobile COVID hospital.

         Q: What’s different about the mobile hospital set up in Mississippi??

         A:  The major medical center at the University of Mississippi in Jackson routinely receives medical transfers from multiple hospitals surrounding it.  With the rapidly expanding number of COVID cases caused by the Delta variant and the low vaccination rate in that state, hospital officials were running out of their ability to provide care.  A request was made for a Disaster Medical Assistance Team (“DMAT”) to be sent in.  This program has been in place for many years and provides rapid deployment of medical staff, beds, medical equipment, supplies, and medications to help in disasters.  Recently, FEMA reorganized how these teams will respond to communities overrun with COVID cases.

Few members of the public are aware of the value of monoclonal antibody therapy developed over a year ago.  This is the medication given to then-president Donald Trump when he was flown to Walter Reed National Military Medical Center and caused his rapid recovery.  Monoclonal antibody therapy is for patients who have had symptoms for 10 days or less, and are not hospitalized because their symptoms have become seriously advanced.  Currently, it is administered by infusion – with an IV being given that takes 2 hours to administer.

On arrival, the DMAT team in Mississippi first set up a 20-bed unit in the parking garage which is limited to only giving these preemptive infusions.  As COVID patients arrive in the emergency department, they are triaged or sorted.  Those eligible for monoclonal antibody therapy are sent to this first DMAT unit for their infusions.  Afterward, each patient is sent home with instructions.  The strategy is to intercept the disease progression thus decreasing the need for acute care beds.  It is an outpatient clinic.  The other 30-bed unit set up in another location in the garage is for in-patient, ICU care for more serious cases.  Manufacturers are currently developing a subcutaneous injection that will replace the infusion now used, reducing the logistics and delays for giving this drug locally.

348. CDC has been criticized for creating confusing messages.

         Q:  Why are the CDC instructions so confusing?

         A:  The CDC gives its guidance in detail trying to anticipate how different groups and situations may need alternative strategies.  Roni Caryn Robin, a reporter at The New York Times highlighted in an article that internal communications within the CDC were clearer than the same messages that were released to the public.  She cited an internal communication giving advice on countering the more infectious Delta variant, “Given higher transmissibility and current vaccine coverage, universal masking is essential.”  The advice issued to the public by the CDC advised Americans, vaccinated or not, to wear masks in indoor public settings in areas with substantial or high virus transmission.  By nuance, the CDC allows people to figure out where, when, and why masks are indicated.  Roni Robin reported the conclusion that it would be more effective to state broad conclusions that safely cover everyone, not requiring people to figure if they are to be included or not.  For example, “In all parts of the country, wear a mask in public indoor settings.”

One can only hope that CDC staff reads The New York Times.

349. Canada allows US citizens in, but the US has just extended its ban on Canadians coming here.     

         Q:  When can my daughter who lives in Canada come here to visit?

         A:  For some time, the border between Canada and the U.S. was closed to nonessential travel on both sides.  Family members, as well as tourists on each side of the line, could not cross over because of COVID-19.  Last month, Canadian officials reassessed the risk of infections and set aside the restrictions for U.S. citizens traveling north.  Canada had hoped that this would be reciprocated by the U.S. to allow Canadians to enter the U.S.  But the Department of Homeland Security said in a tweet a week ago Friday that the restrictions on nonessential travel were still needed to minimize the spread of COVID-19 and the delta variant into the U.S.  It extended the ban until at least Sept. 21.  It appears that the determination of risks differs between nations, and this has caused concerns.

350. Of all the variants discovered so far, only 4 have been named “of concern.”

         Q:  What’s the deal with variants?[1]

         AVariants occur when there is a significant change or mutation to a virus’ genetic code over time.  Variants are natural and expected, especially for viruses like COVID that are spreading widely across several distinct geographic locations.  While many different COVID variants have been detected, the WHO has only categorized four as variants of concern: the Alpha, Beta, Gamma, and Delta variants.

Of these four, the Delta variant is the most contagious.  The original strain of COVID had a reproduction number, R0, between two and three, meaning that on average, each person infected with COVID would spread the virus to two to three more people. The CDC estimates that the Delta variant’s R0 is between 5 and 9.

As long as COVID continues to spread throughout the population, we should expect new variants to continue to emerge over time.

[1] The following information in FAQ 350 was provided by Covid Act Now.