Frequently asked Questions about COVID-19, March 31, 2021

“Shared expectations lead to predictability.”

 241. COVID testing is on the decline while cases rise.

          Q:  Why haven’t I heard more about testing lately?

          A:  The number of daily tests in the U.S. has declined since January by 35 %.  “We have to do more,” Jennifer Nuzzo, an epidemiologist at John Hopkins University stated.  “The pandemic is not over.  We still have dangerously high levels.”  In the meantime, testing methods have improved dramatically.  A new, more effective and less expensive rapid take-home antigen test is now in a clinical trial.  Citigroup is participating in this trial by giving this kit to some of their employees in Chicago and New York.  Each kit consists of a nasal swab, some liquid and a strip of paper.  “It works a little like a pregnancy test,” said Lori Zimmerman, MD, Citigroup’s medical director.   After a swab sample is taken, the test result is available in just 20 minutes.  The goal, Dr. Zimmerman said, is to help people learn if they have COVID before they go to work and can infect colleagues or customers.  If this trial is successful, and if the FDA grants an Emergency Use Authorization (EUA), Citigroup plans to purchase a sufficient number of kits to distribute them to all 6,000 bank branches in the U.S..  This is the ambitious goal that many medical experts are hoping to have quickly available.

A comprehensive testing program for every state can pay for itself.  If a combined testing and vaccination program can exist, the payoff would result in lives saved and businesses and schools being able to reopen safely much earlier.  There are three steps needed to expand the U.S. testing program:

  • Funding: The test being evaluated by Citigroup costs about $5.00 each.  The recently passed U.S. virus rescue legislation provides $50 billion for expanded testing, including $10 billion for schools.
  • Logistical help: President Biden is now establishing coordination centers that can assist state and local authorities organizing area-wide testing programs.
  • FDA approval: This rapid antigen test Citigroup is using will soon be in an application for an EUA to allow widespread use.  Two other rapid tests have already been approved but are more expensive and are not yet widely available.

242. There are currently 18.6% of the Connecticut population fully vaccinated

         Q:  How many people in Connecticut are vaccinated?

         A:  Statistics can be confusing, to say the least.  Let’s clarify the answer.  First, focusing on the word “vaccinated,” statistics are often cited that identify the number of people that have had their first shot.  For two of the vaccines, Pfizer and Moderna, two shots are required spaced weeks apart.  Johnson and Johnson vaccinations require only a single shot.  A better statistic would be to record the number of people who have had all the shots required to gain full immunity.  The term “fully vaccinated.” is used to record this.    The number of people vaccinated (with a first shot) and fully vaccinated people are different.  The percentage of fully vaccinated people will be the data set preferred to allow easier comparison as vaccine levels increase over time.

Thus, the Connecticut percentage of people fully vaccinated last week was 18.6%

To put this number in perspective, the percentage of the population with immunity when the pandemic can no longer continue and will diminish to its end is estimated to be between 75% and 80%.  At that stage, there would be fewer people remaining without immunity to become infected.  This point is often referred to as herd immunity.  Connecticut’s current level of immunity is only about a fourth of that required for herd immunity.  This demonstrates the need for everyone to continue to follow CDC guidelines.  While those who are fully vaccinated are able to visit in-person with other people living in a single household without using masks, the risks are still great if everyone is not wearing a mask while shopping or gathering – indoors and outdoors – in groups.  Social distancing and washing of hands (or using hand sanitizer) remain important regardless of being vaccinated or not.  There is a misperception that once a person becomes vaccinated, they can quickly go “back to normal.”  Those who are not vaccinated quickly pick up on this and also start ignoring the recommended mitigation steps.  Rochelle Walensky, MD, MPH, the director of CDC, on Monday noted that there is a growing upswing in the number of new COVID-19 cases, especially in the northeast (including Connecticut) that is on the verge of blossoming into a fourth major surge.  She sees this as an “imminent disaster” and strongly recommends masks and social distancing continue to be practiced until more people become vaccinated.

243. Some long-hauler COVID survivors profit from vaccinations.

         Q: My neighbor is a long-hauler from COVID last year.  Should she get vaccinated?

         A: During the earlier clinical trials for all the approved COVID-19 vaccines, the issue of prolonged problems and protracted recovery were not known.  Therefore, there are no scientific studies on how vaccines affect “long-haulers.”   Long-haulers are a significant number of COVID-19 survivors, suffering a variety of different continuing issues including fatigue, “brain fog”, nausea, heart problems, migraines, hair loss, chest pains, abdominal pain, asthma, and painful inflammation in eyes.   Many long-haulers have lined up for vaccination shots to guard against becoming reinfected resulting in possible worsening of their conditions.  A scattering (but not all) of long-haulers have reported that after becoming vaccinated, their COVID-19 symptoms have faded away.

Even a year after the outbreak of the disease, scientists have not come to a consensus defining the condition of long-term continuation of COVID signs.   There are also no standard tests or treatments.  Now the group of long-haulers themselves are sharing information to fill this very large gap in knowledge.

Recent studies have shown that between 10% and 30% of COVID-19 cases lead to prolonged medical issues well beyond otherwise usual recovery times.  Some have had serious infections that left organs riddled with damage that take months to be repaired.  Lekshmi Santhosh, MD, A pulmonologist and long-COVID researcher at the University of California San Francisco said that he was optimistic that vaccines will help reduce the seriousness of future infections.  But other long-haulers emerged from less serious cases, even from asymptomatic infections.  Akiko Iwasaki, MD, an immunologist from Yale University proposes three explanations for long-COVID-19 disease:

  • The virus remains in isolated areas of the body, still replication, yet below the level needed to trigger an immune response;
  • Fragments of the coronavirus RNA or other proteins remain in the system, but are unable to replicate;
  • Finally, the immune system has been damaged and is reacting without any pathological remains of COVID-19 being present.

Long-hauler’s post-vaccination outcomes are “all over; it’s anecdotal.” Melissa Pinto, a nurse and long-COVID researcher at the University of California Irvine said.  “We don’t even know what makes a person at risk for long-COVID or how long-COVID happens without a vaccine.”  Much more needs to be studied.

244. In case you missed it, in Connecticut, anyone over age 16 can be vaccinated.

         Q:  The dates get changed frequently.  I’m 18 years old.  When can I get vaccinated?

         A:  As part of the national push to get people vaccinated quickly, Governor Lamont announced that as of April 1, everyone who is 16 and older are eligible to become vaccinated.  Be advised and be patient…  This will include millions of people who will immediately be calling for appointments starting this week Thursday.  And many who secure an appointment may find it is later in the month – or even into May.  Lower your expectations and you will find your path less unpredictable.  The goal is to get everyone vaccinated by the end of May.  The good news is this will lead to the expectation that for summer classes and by next fall, high school students can all be vaccinated.  Trials are now under way for children between ages 12 and 15, and it is possible by the end of summer, children in grades 7 and 8 may become vaccinated.  Elementary school children will likely have to wait until 2022 before they can be vaccinated.

245. More than half the states, COVID-19 cases are rising; is a surge coming?

         Q:  Why are cases rising in several states?

         A:  Even in Connecticut, the total number of daily COVID-19 cases is rising.  With a larger proportion of older people having been vaccinated, the surge in cases is dramatically affecting those who are younger.  Adding to this shift is the large number of young adults who have ignored the mitigation steps of wearing a mask and continuing social distancing.   Spring breaks, parties, opening of indoor dining and sports events are among the attractions for large numbers of people.  Anthony Fauci, MD reported on Monday that scientific data is clearly showing it is the governors, mayors and individuals who are ignoring the CDC guidelines that are the major cause for the expansion of cases.