Frequently Asked Questions About COVID-19 – April 21, 2021

  “Shared expectations lead to predictability.”

 256.  Tracking the progress of Connecticut vaccinations

          Q:  Everyone getting vaccinated is feeling joyous.  But how well are we really doing? 

          A:  We all know that vaccines work.  The more people who get vaccinated, the more they become immune from being infected.  The more rapidly the percentage of people becoming vaccinated rises, the slower new mutations will develop.  Let’s continue to check on how that important metric is progressing,

Percent of People in Connecticut Who Are Fully Vaccinated Each Week for Past 2 Months on Sundays

 

February 28Average per week for 8 weeksApril 18
8.4%18.6%31.6%
                          – Source: Covid Act Now.com   

 

Vaccination Fact #3: The good news is that as more people get vaccinated, the number who have hesitated to get their shots is diminishing.  The bad news is that as time moves along, the high number of COVID cases tends to produce additional variants, some of which are more infectious, thus increasing the number of cases.

As of last week Sunday, 31.6% of Connecticut’s population had been fully vaccinated, leaving 68.4% who are not yet fully   vaccinated.

257. No single variable can explain or predict when COVID will fade away.

         Q. If vaccines create immunity, how come the number of COVID cases are rising as the percentage of vaccinated people is increasing?

         A. There are many variables that affect the risk of COVID spreading or the safety of its diminishing over time. One dynamic that has been identified is that once a person gets vaccinated, they feel they can’t catch the disease.  They stop wearing masks, and gather in crowded settings with impunity.  Scientists have yet to determine if a vaccinated person can still be infected and remain asymptomatic.  There is the possibility that an immunized person can still spread the disease to others without ever knowing they are a carrier.  As we explore ways to predict when it will be safe to reopen at UUS:E, we cannot just look at one set of data like the percentage of the population that is fully vaccinated.  We also have to look at other data such as the number of tests being given to determine if testing is adequate to identify asymptomatic patients.  No single variable can explain or predict when COVID will drop to an acceptable risk.

258. COVID protection for church religious education is parallel to that for schools

         Q:  Why can’t we open up the church now to give my daughter a chance to go to RE?  After all, the local schools are opening up now!

         A:  Everyone wants to get back to normal, and the sooner the better.  But the challenge is to do this safely.  Local schools are opening up following the detailed requirements issued by CDC.  Key among these requirements is that children have to stay 3 feet away from others and there must be adequate ventilation.  It has taken weeks and months for local schools to rearrange space, enhance the ventilation systems, and make purchases just to get ready. The costs for all this have been extraordinary.  So much so that the federal American Rescue Plan Act of 2021 passed last month has already sent out $81B to enable schools to reopen. Another $100B is proposed in the upcoming infrastructure legislation to help schools modify their buildings.  At UUS:E, we are not eligible for any of this federal funding.  And we don’t have enough space downstairs for 3 foot spacing for all our eligible participants.  Without sufficient windows, some of our classrooms cannot just let the fresh air in.  Be assured there are many people working to solve these issues.  And to solve the underlying question of when and how we will reopen.  We are doing this by considering science and safety as being paramount.  You will hear more about this effort soon.

259. The planning now underway to project when it will be safe for UUS:E to reopen is tentatively focusing on 5 variables that are scientifically defined and studied

         Q:  How does science figure in calculating when we can reopen?

         A:  The science of infectious diseases control – epidemiology – is based on evaluating the health of communities, the well-being of populations.  This concept of public health differs from medical health of an individual, which everyone who makes appointments to see a doctor is quite familiar.  If someone views vaccinations only as protection for the one who is getting the shot, that is the perspective of individual medical care.  The public health view is to consider the health of the population.  This requires the inconvenience of wearing a mask and keeping social distancing after being vaccinated – not to protect yourself, but to protect others who may not be vaccinated.  After all, you might still be contagious without having any symptoms.

Nationally, a consortium of public health scientists and statisticians has created a formal system to help groups and organizations study making decisions of when it is safe to reopen their organized activities.  This approach is now being reviewed by UUS:E to help create safe and scientifically driven projections.  The consortium recommends several variables to be evaluated and provides the data to help define the risks for reopening.  We have tentatively selected the following 5 variables using Connecticut data to examine:

  • The first variable, mentioned above, is the percentage of fully vaccinated people;
  • The trend (upward or downward) of daily new cases of COVID-19;
  • The average number of new cases that each contagious person infects;
  • The degree to which the number of COVID tests being given is effective to identify the hidden, asymptomatic patients;
  • The ability to have ICU beds available for new COVID patients needing them.

Daily reports updating data for each of these variables are available.  A standardized grading scale of risk for each variable is also available.  Work is currently underway by the UUS:E Emergency Preparedness Task Force to develop this system for our use,  Everyone interested in this project will soon be hearing more about it.

260. In just a short time, the B.1.1.7 Variant COVID has become dominant in the U.S.

         Q:  What is so different about the “UK variant” strain of coronavirus?

         A:  Studies have shown that the mutant strain of coronavirus first identified in the United Kingdom (properly labeled the B.1.1.1 variant), was first reported to infect a U.S. patient in December.  It is now the most common strain in America.  The main reason for this explosive surge is its higher infection rate – as much as 70% greater than the original coronavirus.  Being more efficient in infecting people, this variant has crowded out the less infectious strains.  It is also more deadly, but this outcome is blunted somewhat by the development of improved therapeutics. One of the observable outcomes of the B.1.1.1 variant was reported by Michael Osterholm, MD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.  He stated, “We’re now seeing substantial numbers of outbreaks in schools and school-related activities.”   One reason for this is obvious – children have not been eligible for vaccination leaving young people as a group more vulnerable, especially to a virus that is more easily transmitted.  A rapidly growing outbreak of COVID-19 in Carver County, Minnesota has been linked to school-sponsored and local sports activity.  A similar outbreak was reported in Dane County, Wisconsin where all the children in a child care center tested positive.

Another problem caused by the B.1.1.1 variant is that  it carries a couple of genetic mutations in the spike protein known as “deletions.”  Part of the genetic codes in the spike protein are missing.  It is the spike protein that triggers antibodies to fight the infections.  The missing genetic codes have been shown to help the B.1.1.1 variant escape these antibodies, enhancing the spread of the disease.  That also allows several commercial testing kits to miss the spike protein gene resulting in false negative test results.  Because young children are not able to keep social distancing on their own, this adds to the further spread of the disease.  The only positive findings from recent studies are indications that children under age 6 cannot easily spread the disease to others including family members at home.

Frequently Asked Questions about COVID-19 — April 14, 2021

  “Shared expectations lead to predictability.”

 251.  Tracking the progress of Connecticut vaccinations

         Q:  Everyone getting vaccinated is feeling joyous.  But how well are we really doing? 

         A:  We all know that vaccines work.  The more people who get vaccinated, the more they become immune from being infected.  The more rapidly the percentage of people becoming vaccinated rises, the slower new mutations will develop.  Let’s continue to check on how that important metric is progressing,

Percent of People in Connecticut Who Are Fully Vaccinated

 

March 24March 31April 7
18.6%20.4%%39.1%
       – Source: Covid Act Now.com

 

Vaccination Fact #2: The data on our COVID vaccinations only goes back to the clinical trials that scientifically studied their risks and effectiveness leading to FDA approvals.  These trials are continuing and we learn more about the vaccines over time.  One study is how long the immunization will last.  So far, scientists have determined that the protection from infection lasts for at least 6 months – the period studied so far.  This estimate may be extended as demonstration of immunity continues over time.

As of last week Wednesday, 39.1% of Connecticut’s population had been fully vaccinated, which was 19.3% more than a week before.  This was a significant increase.

252. An insight: “Oh, I get it now!”

        Q:  I get so confused about public health statistics; I don’t even read them anymore!

        A:  Try this… please read on, we’ll make it short!  Children.  Birthday parties.  Musical chairs.  A circle of 10 chairs with children.  The music starts and the kids get up and walk around the chairs.  One chair is taken away, and the music stops.  The child who cannot sit down leaves the group and after a bit the music starts again.  As this is repeated, if an average of 9 children for every 10 has to leave the group. The ratio by which the number remain after the group shrinks will be 9 out of ten.  The shorthand way to say this is .9 is the ratio of children remaining with chairs.  Instead of “children with chairs,” substitute “COVID-infected patients.”  If a group of 10 COVID-infected patients infect only 9 new patients, the “rate of infection” would be .9.  If the rate of infection is below 1.0, the disease will eventually disappear.   Did this help?  Can you now say, “Oh, I get it now!”

253. Science and data should be used to decide when our UUS:E can reopen.

         Q. When will UUS:E reopen the church for indoor activities and services?

         A. The State of Connecticut has established minimal guidelines that allow many groups to reopen. We see examples all around us.  The need to “return to normal” is universal, and lowering the standards for restaurants, businesses, theaters, and sports events satisfy our economic and psychological interests.  But are they safe?  Look at some of the data that frames Connecticut now, as these loosening of restrictions are made:

  • Less than half the population is fully vaccinated,
  • The percentage of Connecticut’s population being infected with COVID has risen dramatically since March 1,
  • the infection rate that defines if the number of infected patients is rising or going down shows a steadily increasing surge since February 1.

As a general observation, states all around the country have opened up as soon as it looked like COVID was getting under control, only to reimpose restrictions later.  This cycle has happened over and over again.  Right now, Connecticut and most of the other states are beginning what the CDC is calling the “Fourth Surge” of COVID cases.

The good news is that there are several data sources that can serve as “prevention predictors.”  If the percentage of the population being vaccinated rises to a high enough level, there will not be enough people remaining without immunity to become infected.  That data can be used along with others to better predict when it will be safe to reopen.  The Emergency Preparedness Task Force at UUS:E has begun examining these “prevention predictors” to answer that important question of reopening.  One key prevention predictor will require children to be authorized by the FDA to receive their shots, and vaccinations delivered before that safe level of population can be reached.  That may take at least until September, 2021.  Updates on the essential data being reviewed and the predictions they point toward will be reported frequently in future FAQ columns.

 254. Compliance with CDC guidelines will shorten the time to control COVID

          Q:  How do people refusing to use masks when shopping affect the control of COVID?

          A:  The Atlantic published an article on April 4 that was highlighted: “vaccinated and unvaccinated people are getting more lax with behavior at a time when vigilance really matters.”  This article was authored by Katherine J. Wu, Ph.D., who is a science and health reporter for the New York Times.  She holds her degree in microbiology and immunobiology from Harvard University.  She is writing about people who are struggling to navigate the new world of partially vaccinated people. “Even as infection rates tick up again, people are bending, stretching, and breaking the rules,” she states.  When she wrote the article, only about one-fifth of the population had been vaccinated.  At that point, the CDC had given the okay for vaccinated people to visit others who live in the same households without wearing masks.  Yet people were openly visiting anyone in small groups anywhere.  She also points out that “across the country, states are rushing to lift mask mandates, tolerance for social distancing is flagging, and vaccinated people are amending the new guidelines as they see fit.”  She continues, “Amid all the fudging, the sentiment is starting to become a constant refrain: ‘Really, what’s the harm?’

She answers that question by saying, “The harm is frankly mathematical.  Over time, our vaccine cheat days start to add up.  Now is not the time to relax – quite the opposite.  The problem is our lapses don’t just slow us down.  They set us back in the same way that repeatedly opening the oven door will prolong the time it takes to bake a cake (and, at worst, make your delicious cake collapse).  Having made so much progress, we risk a lot with our impatience.  And right now, we’re in serious danger of botching our grand pandemic finale.”

She quotes an expert in behavioral economics that it’s human tendency to take any ambiguity or uncertainty in guidance and spin it toward a most favorable outcome.  People are always looking for a loophole to justify what they want to do.  Another factor was discussed.  At the beginning, the perception of risk from the unknown was threatening.  Compliance with guidelines was easier.  But with vaccinations, people have the perception of reduced risk and greater safety.  This shift in perception leads to a lessening of compliance with existing guidelines.

Dr Wu concludes her discussion with a warning, “we can’t take the pandemic’s endgame for granted.”  To forestall the possibility of new mutations occurring, “we still have to consider our collective risk, not just our risk as individuals,”

255. More evidence of blood clots from the AstraZeneca vaccine.

         Q:  Is it true that the AstraZeneca vaccine is still producing blood clots in patients?

         A:  In Europe, the agency that reviews vaccines and therapeutics for safety and effectiveness is known as the European Medicines Agency (EMU).   This agency is the equivalent to our Food and Drug Administration (FDA).

The EMA recently reported very rare cases of blood clots forming in patients who had been given the AstraZeneca vaccine.  Political leaders in more than a dozen countries in the EU have requested they stop using this vaccine, and an emergency meeting has been called.  This marks the second time that AstraZeneca has been challenged with this same finding.  Public health officials have again reported that “the risk to the general public of getting a serious blood clot is very small compared to the risks from possible COVID-19 infections – which itself can also cause similar clots.  AstraZeneca is the most available vaccine in Europe, and it costs less than other vaccines.  This political perception of threat is having a dramatic effect of slowing down the vaccination of people in Europe.  It is distressing to see how risks can be perceived so differently.  This is one case where the cost of the cure is NOT greater than the disease itself, despite public perceptions.

Frequently Asked Questions about COVID-19 — April 7, 2021

  “Shared expectations lead to predictability.”

246.  Tracking the progress of Connecticut vaccinations

         Q:  Everyone getting vaccinated is feeling joyous.  But how well are we really doing? 

         A:  Many people are eagerly looking forward to getting rid of the COVID-19 disease.  There is raising political expectations to quickly reopen the economy.  Yet it’s truly difficult to know where we really are.  Especially now when science is telling us the number of cases are actually rising, and younger people are now more at risk than before.  Let’s begin by identifying measures that we can examine over time to chart how we are actually doing as we progress.  Take, for instance, vaccinations.

We all know that vaccines work.  The more people that are vaccinated, the more people become immune from being infected.  The more rapidly the percentage of people becoming vaccinated rises, the slower new mutations will develop.  Let’s start checking how that important metric is progressing,

Percent of People in Connecticut Who Are Fully Vaccinated

 

March 24March 31
18.6%20.4%
       – Source: Covid Act Now.com

 

Vaccination Fact #1:  There are two ways to measure when people get vaccinated; when they get their first shot, or when they get the number of shots needed depending on the manufacturer.   For Johnson & Johnson, they become fully vaccinated after one shot.  For Pfizer and Moderna, full vaccination comes after two shots that are weeks apart.  The metric of “full vaccinations” is more accurate to determine those who have the greatest immunity from all the different vaccines.

As of last week Wednesday, 20.4% of Connecticut’s population had been fully vaccinated, which was 1.6% more than a week before.

247. Experts agree that to fully control COVID, children need to be vaccinated.

         Q:  If herd immunity requires 75% to 90% of the population to be vaccinated, can we get there without children being inoculated?

         A:  Children can spread coronavirus-19 to other people.  It is estimated that children from birth to age 17 make up 22.1% of the U.S. population.  While it is true that there is wide variability by age on exposure opportunities to become infected and social interaction to spread the disease, the immunity controlling the infecting of others requires that children must be vaccinated.  “We’ll never get to that immunization level of herd immunity until we vaccinate kids,” says Jennifer Nayak, division chief of pediatric infectious diseases at the University of Rochester Medical Center in New York.  Even if the U.S. reached herd immunity among just adults, local clusters of population below that protected status would allow the disease to continue being spread.  That’s where unvaccinated children may play a critical role, says Dominique Heinke, a researcher and epidemiologist in North Carolina.  Variants also play a role in this dynamic.  Vaughn Cooper, a microbiologist and molecular geneticist at the University of Pittsburgh, identifies that the Africa variant B.1.351 and Brazil variant P.1 can infect people with immunity from previous natural infections.  “That basically creates more chances for more infections in adults and more opportunities for transmission and subsequent evolution,” Cooper said.  “We’re not going to be able to stop that until we stop transmission among kids.”

None of the approved vaccines now in place were clinically tested for anyone under the age of 17.  Clinical trials are now underway for children ages 12 to 16.  The findings to date look promising for this age group, and approval may take place for vaccines to be administered to middle and high school aged students before the start of the next school year.  Testing for children from birth to age 11 is yet to be held and vaccination of these children will probably have to wait until 2022.

248. New therapeutics for those who contract COVID-19 are in development.

         Q. Are there any new drugs being tested to treat COVID?

         A. Pfizer, well known for its pioneering work on developing and testing a vaccine to prevent people from getting the disease, has developed an oral antiviral medication for people to take if they do get infected. Early trials have begun on this candidate drug, currently inauspiciously named as “PF-07321332.”  It is a protease inhibitor that prevents the virus cells from replicating in the host cells.  Pfizer is also studying an intravenous antiviral therapeutic for treating COVID-19 patients who are hospitalized.   Merck & Co., Roche Holding and Atea Pharmaceuticals are in mid trials for their different antiviral drugs.  The FDA has already issued an Emergency Use Authorization (EUA) to Eli Lily for its drug Bamlanivimab alone and in combination with Etesevimab and a combination therapy with Regeneron.  There is even additional therapeutic research going on with obvious advances in treating patients who become infected.

 249. While we are entering a fourth surge of COVID-19, this one may be different.

         Q:  Why are the number of COVID cases  rising as more and more people are being vaccinated?

         A:  The people representing the number of rising cases are primarily those who have not been vaccinated.  While just over 20% of Connecticut people have been vaccinated, 4 out of 5 people have not.  The role of mutant or variant viruses may also play a role.  The infection rate of some of these variants means that a higher percentage of unvaccinated people are now more likely to get the disease than when the pandemic first emerged.  America as a nation is entering this fourth surge with a strong advantage over other countries.  We have a much stronger effort to produce and administer vaccines.  As we push toward the goal of herd immunity, we are curtailing the number of infected people providing the opportunity for new variants to emerge.  However, it has to be recognized that herd immunity is not a binary threshold; we are not all safe or all unsafe at any one time.  It is not a switch where we go instantly from one to the other.  Instead, it is a threshold where the continuing disease no longer can sustain itself over the long term.  Once herd immunity is achieved, people will still get sick and may die, but in steadily diminishing numbers.

250. Confusion and controversies delaying plans for a “COVID Passport.”.

         Q:  Where can I get a passport that verifies, I have been vaccinated?

         A:  Like so many components of our previous administration’s public health policies, the responses to COVID-19 have been fragmented, unrecognized or not planned in advance.  This has resulted in controversy and unexpected interruptions.  A “COVID passport” is an officially valid document that verifies the holder has been vaccinated.  In January, President Biden issued an executive order directing agencies to assess the feasibility of digitally linking coronavirus vaccinations to previously existing vaccine cards also known as “international certificates of vaccinations or prophylaxis.”  Andy Slavitt, a senior advisor to the current White House Coronavirus Team said a week ago that it is not the role of government to create such a document or to hold that kind of (medical) data on U.S. citizens.  Yet the Biden Administration will provide guidance to the private sector on this effort.  Slavitt projected that an ideal coronavirus passport should be free, equitable, secure, accessible, in multiple languages and be available both digitally and on paper.  The scope identifying the users of such a system remains unclear.  The travel industry is strongly advocating this to encourage passenger safety by allowing employees of airlines, cruise ships, bus and train services to deny boarding of those passengers who have not been vaccinated.  Others sponsoring concerts and sports events want to use this to identify those vaccinated before allowing entry to stadiums, arenas and theaters.  Politically, there is the expressed fear that coronavirus cards would lead to demands by employers to show proof of vaccinations (which many Republicans want to dissuade people from taking) before being hired.  Fear of publicly providing private, personal medical information is touted to discourage having such documentation.

Early in the vaccination process, the CDC cards filled out at vaccination sites were publicly discouraged from being posted on social media sites to proudly proclaim their vaccinated status.  People were cautioned that photocopies of these cards could easily be duplicated by those people who are opposed to being vaccinated to become eligible for travel or admission to large venues without getting their shots.  The CDC card does not have a photo on it to identify that the holder was the person who was vaccinated.  Also, not all vaccination sites provide these cards.  If a private company is to be awarded a contract to provide these passports, several other barriers remain.  Where is the data base located with the data of all vaccinated people located?   If pictures have to be included, do people have to appear somewhere for this?  There is much more discussion to take place before we will have coronavirus passports.

 

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.

Frequently Asked Questions about COVID-19, March 24, 2021

  “Shared expectations lead to predictability.”

 236.  Science v. science! Different decisions from looking backward or forward.

          Q:  Why are some scientists disagreeing with the CDC about relaxing restrictions?

          A:  Michael Osterholm, Ph.D., MPH, is the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.  He had served President Biden on transition team advising on plans to manage the pandemic.  After the inauguration, he now is outside the government, but he retains his decades-long reputation at predicting the course of infectious diseases.  For weeks, he has been one of many scientists opposed to CDC guidelines for slowly relaxing the preventive measures for controlling COVID-19.  The premise of his opposition is that CDC bases its recommendation on scientific examination on how COVID-19 has reacted in the past as preventive measures have been introduced.  These retroactive studies can predict how various measures can control the disease studied.  It also identifies measures no longer useful that can be loosened.  Dr. Osterholm has studied the mutations of the coronavirus-19.  Variant strains or mutations can change the way past measures may have value in the future.  This prospective view requires a different approach for making decisions.

Dr. Osterholm has classified the variants into three groups based on their effects.  First are those variants that are more infectious than the original strain.  Next are the mutations that evade some or all the natural immunity or protection offered by current vaccines.  Finally, are the variants that are more virulent – not affected by any of the therapeutics or treatment procedures we have learned over the past year.  He points out that a particular variant may have one or more characteristics of each of these classifications.  The UK variant may be 60% more infectious, but vaccines and therapeutics can prevent hospitalizations or death.  The newly discovered New York variant may be even more infectious than the UK variant, but it may also evade protection from natural or vaccine immunity.  A future variant that is more infectious, evades natural or vaccine immunity and is also more virulent could be unlikely, but quite possible.  And this would be quite disastrous.  Dr. Osterholm’s perspective is to shift from a primary focus of changing guidelines based on retrospective studies, and instead first focus as a priority our full attention on significantly reducing the very large caseload of infected people through accelerated vaccinations.  This will greatly reduce the emergence of new variants significantly reducing this underlying threat.

The CDC last week came out with new guidance for opening schools.  A thorough scientific study of schools in Massachusetts demonstrated that seating students wearing masks in grades 1-6 closer than 6 feet apart did not increase their risk.  That was a retroactive study.  Dr. Osterholm had urged the CDC to delay its new guidance that student seating at 3 feet apart would be the “new normal” until more prospective analysis could be done.  It might be more difficult to change back to 6 feet distancing in just a few weeks if it is learned that these current new variants are more infectious than the one studied retrospectively in Massachusetts.  A better understanding of retrospective v. prospective factors may help slow down the decisions needed for a successful outcome.

237. Europe is facing a major COVID surge with lockdowns being put in place. 

         Q. Why are several European countries now being locked down because of COVID?

         A. It is true that European countries are experiencing a rapid daily increase in the number of COVID-19 cases resulting in a third wave. Three countries, the U.S., Israel, and the United Arab Republic have rapidly deployed an increased production of vaccines to their citizens, and this correlates to the reduction of their cases in the past several weeks.  European countries have lagged in vaccinating their citizens, correlating with this oncoming surge.  The New York Times last week tracked the 3 major reasons for this difference.   First was the focus on bureaucracy.  The EU spent much time working to get the 27 nation members to negotiate and sign an agreement with manufacturers on how to fairly allocate the vaccines throughout the EU.  Their initial approach placed process over fast development and rapid availability of the vaccines.  Second was reluctance to invest the funds needed for rapid deployment of the vaccines.  Time was spent on negotiating low prices.  Israel paid Pfizer for each rapidly available dose about $25, the U.S. about $20 and the EU paid from $15 to $19.  From a national standpoint, the money saved by a lowered price will be more than offset by greater economic losses from having to initiate new lockdowns.  The third factor is vaccine skepticism.  In a published survey asking if they would take a proven-safe and effective COVID vaccine, in China 89% of the people said yes.  In the U.S., 75% agreed.  As did 68% in Germany, and 65% in Sweden, 59% in France, and 56% in Poland.  Another variable at play is the lack of confidence in the EU over the medical science approving vaccines.  After authorizing the AstraZeneca vaccine in the EU, a news report was published that several patients had developed blood clots.  France’s President Macron last week made the political decision to block this vaccine from being used.  Germany and Italy followed suit.  Scientists have pointed out that the percentage of vaccinated patients with blood clots was less than those in the general populations.  The WHO is now urging the return of AstraZeneca to wide-spread use.

238. CT Freedom Alliance continues to ask courts allow students to avoid masks.

         Q:  I read in the Hartford Courant that a group is suing to let students not wear masks in school.  Won’t that put others at risk?

         A:  This is a continuation of seven months of court action by the Connecticut Freedom Alliance to remove restrictions on opening schools during a public health emergency.  In this instance, the group had filed a request to Superior Court Judge Thomas Moukawsher for a ruling without a full trial to invalidate Governor Lamont’s order that children attending in-person classes in schools must wear masks.  The Alliance’s position is that wearing masks is not only dangerous to a child’s heath but that “children are constitutionally entitled to a physical learning experience under the Connecticut Constitution.”  Judge Moukawsher issued a 36-page ruling denying the request.  Governor Lamont has recently been subject to criticism over his issuing of nearly 100 executive orders dealing with the pandemic.  Other cases have been heard in court, and many of these are causing appeals to be heard by the Connecticut Supreme Court.  The Freedom Alliance will be included in the Supreme Court case by asking it to overturn the denials given by Judge Moukawsher.  Who is right – parents who want their freedom to decide what’s best for their children, or the government to protect the public health?  That question frames many discussions about how well – even if – we will ever end this pandemic.

239. Follow up: U.S. stockpiled AstraZeneca doses to be given to other countries.

         Q:  Is Biden going to follow his plan by giving spare COVID doses to other countries?

         A:  In last week’s column, it was identified that the “National Strategy for the Covid-19 Response and Pandemic Preparedness” plan called for the U.S. to join with the approximately 190 other countries to participate in a global vaccine distribution agreement called COVAX.  In this agreement, participant countries agreed to share vaccine doses with other countries that are unable to produce enough for their people.  AstraZeneca now has tens of million doses of vaccine in storage in the U.S. that can’t yet be used here because it has yet to be approved by the FDA.  Yet this vaccine has been approved by 70 other countries.  Earlier, President Biden continued making courtesy calls to national leaders around the world.  While broadly discussing issues with the president of Mexico, Andrés Manuel López Obrador, Biden mentioned the problem of children crowding our mutual border overwhelming the U.S. immigration system.  It was reported that during that call, an impromptu agreement was reached to explore the possibility of Mexico helping us restrict Central American citizens coming into Mexico before traveling north to our border.  In exchange, we would ship millions of doses of AstraZeneca vaccine to help Mexico immunize its citizens.  Before the deal was formalized last week, Canada had been brought into the deal.  As a result, large quantities of our stored vaccine will be sent to both Canada and Mexico as those countries help us with our immigration problem!

240. OSHA is planning to release regulations requiring masks in the workplace.

         Q:  Many of my friends want to get back to normal right away.  How will things change?

         A:  The CDC is contemplating guidelines for returning to work.  CDC guidelines are only recommendations, and previous problems in the workplace, especially in meat packing plants led to guidelines being ignored.  Former President Trump encouraged this avoidance.  The Occupational Health and Safety Administration within the U.S. Department of Labor is one federal agency with the power to enforce workplace safety standards.  The interim guidelines being considered is to require masks to be worn by all employees in a workplace where they may come within six feet distance of others during the time at work.  This requirement would probably be temporary, until the pandemic was under control.  But how well would such a rule be received by businesses and by the public?  A lot of discussion is taking place at CDC – and OSHA.  It will be interesting to watch this unfolding program.  Related to this is another workplace consideration being talked about: can an employer require their employees  be vaccinated before they can remain on the job, return to work, or be initially hired?

Frequently Asked Questions About COVID-19, March 17, 2021

  “Shared expectations lead to predictability.”

 231.  National COVID-19 Strategic Plan – (Part 8 of 8)

         Q:  What’s in the new United States strategic plan for controlling this pandemic?

         A: On January 21, 2021, President Joe Biden released the 198-page National Strategy for the COVID-19 Response and Pandemic Preparedness.  This week’s summary gives details about:

Goal 7 – Restore U.S. leadership globally
and build better preparedness for future threats.

 

The plan states, “The federal government will restore America’s leadership role in preventing, detecting, and responding to global crises, advancing global health security and the Global Health Security Agenda.”  To accomplish this, the government will:

  • Restore the U.S. relationship with the World Health Organization and seek to strengthen it.
  • Surge the International COVID-19 public health and humanitarian responses.
  • Restore U.S. leadership to the international COVID-19 response and advance global health security and diplomacy.
  • Build better bio-preparedness and expand resilience for biological threats.

This goal includes multiple details of steps to be taken within each of these topics.  It is apparent that many of these details had been achieved by earlier administrations and were eliminated over the last 4 years.  Replicating them is well defined in the memories of current administrators and they are listed to catalog this current effort in its detail.

The Biden administration is taking steps to address an issue in the second bulleted item, above.  A detail in the US Strategic Plan states the U.S. will join with the approximately 190 other countries to participate in the global vaccine distribution agreement (COVAX).  In this agreement, participant countries agree to share vaccine doses with other countries that are unable to produce enough for their people.  AstraZeneca’s vaccine has already been approved and is being used by 70 other countries.  But not in America!  AstraZeneca has yet to submit the required data for FDA approval, and this is not expected until April at the earliest.  AstraZeneca now has tens of millions of doses of vaccine in storage in the U.S. that can’t be used here.  President Biden on March 12 participated in a meeting with “The Quad,” a group already formed including leaders of Australia, India, Japan and the U.S.   The Quad’s focus is to address the challenges of economic and geopolitical challenges from China.  At this meeting, Biden agreed to help fund and support production and distribution of vaccines within these other countries.  As to the immediate donation of our stockpiled vaccines to other countries, “Stand by!” to see how that issue will be resolved.

232. CDC guidelines for childcare centers released

         Q. The CDC promised guidelines for childcare workers. Where are these?

         A. Parents are delighted that in-school education is on the horizon. This will allow many to return to work as businesses are allowed to open.  But what about preschoolers?  What do parents look for to be sure children will be safe?  On March 12, last Friday, the CDC issued an extensive updated guideline document for child care centers.  This revision addressed changes from the earlier standards and now include:

  • Current knowledge about COVID-19 and transmission at child care centers;
  • Mask wearing;
  • Ventilation and water systems;
  • Children with special needs and disabilities;
  • Using co-horting and staggering strategies;
  • Communal spaces, food service, playgrounds and play areas;
  • COVID-19 screening and knowing signs and symptoms;
  • Protecting people at higher risk;
  • Managing direct service providers.

These guidelines include the importance of all adults in the center being fully vaccinated.  Child care workers are included along with teachers in the directive indicating immediate acceptance for appointments to become vaccinated.  Masks on children over the age of 2 are also recommended.  No masks for under 2.  Specific guidance on changing diapers, coddling, and feeding infants, and transporting children are specified.

Each child care center that is reopening is urged to prepare an emergency operations plan (EOP) addressing all the issues in this new guidance.  Parents who are planning to use a reopened child care center, can ask for a copy of its EOP to review.  The current CDC guidelines can be found on the internet.[1]

 https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html#print

 233. Coronavirus variants being studied – some may present a grave risk, but we just don’t know! (Yet!)

         Q:  There is so much discussion about the variants of COVID-19.  What is the problem?

         A:  An interesting scientific on-line article was just published by National Geographic that provides some insight.  “The fear is that some of these variants… could diminish the power of our vaccine arsenal.  That’s because people who have been vaccinated, or who gained immunity through natural infection, may still be vulnerable to these variants – a vulnerability that’s at odds with recommendations the U.S. CDC released saying that vaccinated people could safely gather indoors with other vaccinated people.”   Stuart C. Ray, an infectious disease professor at Johns Hopkins Medicine in Baltimore, stated, “The needle of public opinion is clearly tilted toward relaxation, but with the high rate of current infections in the U.S., and the variants of concern on the rise, we may regret it.”   Currently, health officials are trying to gauge the threat of several domestic varieties, including one originating in New York, and the other in California.  Dr. Anthony Fauci told host Margaret Brennan on Face the Nation that he was concerned about the spread of the variant B.1.526 that originated in Manhattan just weeks ago.  Early findings show it might not be affected by antibodies from vaccines, and that therapeutics may also have limited effects. Another new variant originating in California (CAL.20C) is increasingly found in new cases.  New variants are emerging more rapidly than ever; any of these could be the one creating greater risk.  Many scientists are urging patience.  Research has yet to demonstrate what many fear.  But patience is also urged against assuming the pandemic is now over.  In any event, while vaccines account for a drop in cases, only 11% of the population has been fully vaccinated, far below the expected 75% required to achieve herd immunity!

234. Politics over science appears to still dominate – among Republicans.

         Q:  Why does the U.S. House of Representatives still vote in small groups with most members remaining away from the House chamber when it is in session?

         A:  A recent survey by the American news website Axios showed that 25% of the members of Congress have refused to be vaccinated – all of them Republicans.  Vaccinations were offered to all members of Congress in January.  But many Republicans are not identified as having taken it.  Some may have received their vaccination at home, some may have avoided it because of medical conditions.  But these have not been reported to the House Office of Attending Physician.  Following CDC guidelines, voting on motions and bills take three times longer than pre-pandemic because it has to be done with small groups scheduled to come into the chamber from their offices and elsewhere.

But this is not the only way Republications are rejecting vaccinations!  On March 11, a PBS NewsHour/NPR/Marist poll was released.  A total of 1,227 adults were surveyed with about 30% responding they did not plan to get vaccinated.  What was surprising was that 49% of Republican men said they would not get the vaccination.  Many cited reasons that followed old political arguments including “COVID was not that serious a disease.”   Leana Wen, MD, A professor at George Washington University and an emergency physician reported that this block of deniers, by itself, could prevent the nation from achieving herd immunity and allow the disease to become endemic and recur annually.

235. Americans support restricting unvaccinated people from offices and travel.

         Q:  Many of my friends want to get back to normal right away.  Isn’t this feeling universal?

         A:  A Reuters/Ipsos poll was released on Friday, March 12.  This poll of 1,005 people shows that 72% of the people felt it was important for them to know that people around them have been vaccinated.  The majority – 62% – said that unvaccinated people should not be allowed to fly on an airplane.  55% said that only vaccinated people should work out in a public gym, go to a movie theater or attend a concert.  When asked about the workplace, 60% of Americans said they wanted to work for an employer “who requires everyone to get a coronavirus vaccine before returning to the office.”  This poll raises the important issue: how do people show that they have actually been vaccinated?  Copies of the CDC Vaccination Card do not have a photo ID, and can be easily copied for use by other people.  And if someone loses their card, there is no way a duplicate can be obtained.  There is (yet) no centralized registry of people that received the vaccine including the dates given.  How will this be addressed?  “Stand by!”

[1] You can copy the entire URL (in blue and underlined), then paste it in your browser to open this document.

Frequently Asked Questions about COVID-19, March 10, 2021

  “Shared expectations lead to predictability.”

226.  National COVID-19 Strategic Plan – (Part 7 of 8)

         Q:  What’s in the new United States strategic plan for controlling this pandemic?

         A: On January 21, 2021,  President Joe Biden released the 198-page National Strategy for the COVID-19 Response and Pandemic Preparedness.  This week’s summary gives details about:

Goal 6Protect those more at risk and advance equity, including across racial, ethnic and rural/urban lines.

The plan states, “The federal government will address disparities in the rates of infections, illness and death among communities defined by race, ethnicity, geography, disability, sexual orientation, gender identity, and other factors.”  The United States will:

  • Establish the COVID-19 Health Equity Task Force’
  • Increase data collection and reporting for high risk groups;
  • Ensure equitable access to critical COVID-19 PPE, tests, therapies and vaccines;
  • Expand access to high quality health care;
  • Expand the clinical and public health workforce;
  • Strengthen the social service safety net to address unmet basic needs; and
  • Support communities most at risk for COVID-19

Next week: details about Goal 7 – Restore U.S. leadership globally and build better preparedness for future threats.

227. CDC Guidelines for vaccinated people

         Q. The CDC promised guidelines for vaccinated people. Where are these?

         A. The updated set of guidelines was published on Monday, March 8. Because full immunity is acquired after 14 days from receiving both shots for the Pfizer and Moderna vaccines, (or the single shot for the Johnson & Johnson vaccine), these guidelines apply when a person has full immunity.  The new guidelines state, “Based on what we know about COVID-19 vaccines, people who have been fully vaccinated can start to do some things they had stopped doing because of the pandemic.  We’re still learning how vaccines will affect the spread of COVID-19.  After you’ve been fully vaccinated against COVID-19, you should keep taking precautions in public places like wearing a mask, staying 6 feet apart from others, and avoiding crowds and poorly ventilated spaces until we know more.”

Specific activities are listed that are changes from what unvaccinated people must continue to follow:

  • You can gather indoors with fully vaccinated people without wearing a mask.
  • You can gather indoors with unvaccinated people from one other household (for example, visiting with relatives who all live together) without masks, unless any of those people or anyone they live with has an increased risk for serious illness from COVID-19.
  • If you have been around someone with COVID-19, you do not need to stay away from others (self-isolate), or get tested unless you have symptoms.
    • However, if you live in a congregate setting (g., rehabilitation hospital, nursing home, etc.), you should stay away from others for 14 days.

Vaccinated people are advised to delay domestic or international travel.  If someone does travel, they need to follow all the guidelines for unvaccinated people.  You are advised to follow all guidelines at your workplace, even if you are fully vaccinated.

Studies are continuing to evaluate several factors that may influence these guidelines:

  • How the different variants (mutations) are affected by the vaccines;
  • How long the vaccines and recovery from COVID-19 provide immunity;
  • How effective vaccines are at preventing the spread of new infections.

 228. It’s a myth – “Vaccines present a clear path for a return to normal!”

         Q:  My husband tells me that because there is a vaccine, we can now ignore all restrictions and return to normal.  Is that true?

         A:  No.  In spite of this being touted as a political position in Texas, Alabama and Mississippi, the science of epidemiology warns that many bumps lie in the road ahead that if not managed, could even lead to COVID-19 becoming an endemic long-term pathology like the common cold or seasonal influenza.  This is with, of course, more serious implications for death and disability.  Chris Murray is the Director of the Seattle-based Institute for Health Metrics and Evaluation.  His position is changing on the course of this pandemic.  His premise until recently was that the emerging vaccines along with the immunity built up after recovering from COVID-19 would eliminate the disease entirely.  He recently reviewed data from a clinical trial in South Africa.  It showed that a rapidly spreading variant of the disease could not only dampen the effect of the vaccine, it could also evade natural immunity in people who had been previously infected.  Reuters News Service recently interviewed a panel of 18 scientists who have reviewed the data from South Africa and Brazil.  Reuters reported, “the consensus is now emerging that COVID-19 not only will remain with us as an endemic virus, continuing to circulate in communities, but will likely cause a significant burden of illness and death for years to come.”  It was also reported that some hope lies ahead with the ability to genetically modify the mRNA in vaccines to address these issues and make booster vaccines to increase the effectiveness against these and subsequent variants that emerge.

A new study has also been reported by a group of scientists looking at another variant (“501Y.V2”) recently discovered in South Africa.  This variant is the main driver of South Africa’s second wave of COVID-19 infections, which hit a new daily peak of 21,000 cases earlier this month.  The study shows that a common treatment for COVID cases is convalescent plasma.  Plasma, containing antibodies from recovered COVID-19 patients, is injected, usually resulting in improved patient outcomes.  Persons infected with this new variant, however show greatly reduced improvement.  For some reason, this mutation defeats this common therapeutic that is widely used.  The result is a higher rate of serious disease and deaths as an increasing number of people become infected.

It seems the more we learn, the more questions emerge.  As this quest continues, we find old assumptions have to change.  And while the scientists struggle to keep up, the public can easily get confused.  Stand by!

229. Airplane cabin air in flight has really low particulate levels.

         Q:  When flying, we’re cooped up in an enclosed cabin.  How safe is this for avoiding COVID-19?

         A:  A research paper was recently published by the Georgia Institute of Technology.  It reported, “If you’re looking for an indoor space with a low-level particulate air pollution, a commercial air liner flying at cruising altitude may be your best option.”  The study compared the air quality in stores, restaurants, offices, public transportation and commercial jets.  In flight, jet planes ranked with the lowest levels of particulates.  All jets use filters for ventilating air through the cabin.  And when in-flight, outside air is brought in to mix with recirculating cabin air.  Opening the vent overhead to bring a rush of filtered air around you – on the ground as well as inflight – will help reduce the concentration of any infectious particles from nearby passengers.  And it is still recommended you wear a mask at all times when in the airplane.  Put your peanuts and pretzels in your pockets, refrain from eating meals in flight if possible, and ask for a straw to sip drinks – even coffee or tea – while leaving your mask in place.

230. COVID-19 vaccines for animals is being tested and used.

         Q:  Why am I hearing that some zoos are vaccinating their animals against COVID?

         A:  In addition to early reports that some domestic pets – cats and dogs – had been displaying symptoms of COVID-19, scientists now have found this disease has also been found in mink, ferrets, cougars, lions, tigers, snow leopards, and the great apes (gorillas and orangutans).  Zoetis is a company that manufactures veterinary pharmaceuticals.  Zoetis has been testing its animal COVID-19 vaccine on cats and dogs with success.  Earlier this year, at the San Diego Zoo, an orangutan named Karen came down with COVID symptoms.  Karen and three other orangutans live together as a troop – and 5 great apes – bonobos – also are residents at this same zoo.  In February, all these apes were given the Zoetis vaccine.  Karen is doing well in her recovery, and the other apes are showing the vaccine to be safe and effective.  Aside from protecting the investment zoos have made in their animals, there are other significant reasons why veterinary vaccines are important.  It is estimated there are only 5,000 gorillas in the world living in the wild.  They live in tight-knit groups called troops.  If COVID infection were to spread to these native gorillas, they could easily face extinction.  Globally, commercial mink farming has been devastated by COVID infections this past year.  Animal vaccinations will allow this business to rebound in the years ahead.

Frequently Asked Questions about COVID-19 — March 3, 2021

  “Shared expectations lead to predictability.”

 221.  National COVID-19 Strategic Plan – (Part 6 of 8)

         Q:  What’s in the new United States strategic plan for controlling this pandemic?

         A: On January 21, 2021, President Joe Biden released the 198-page National Strategy for the            COVID-19 Response and Pandemic Preparedness.  This week’s summary gives details about:

Goal 5 — Safely reopen schools, businesses
and travel while protecting workers.

The plan states, “The United States is committed to ensuring that students and educators are able to resume safe, in-person learning as quickly as possible, with the goal of getting a majority of K-8 schools safely open in 100 days.”  The strategy for safely reopening schools, businesses and travel will:

  • Ensure adequate supplies;
  • Guarantee full access to FEMA disaster relief and emergency assistance for K-12;
  • Support implementing COVID-19 testing;
  • Develop and release detailed technical guidance on safely reopening schools;
  • Working with state and local officials to understand barriers and to shape policy;
  • Create a Safer Schools and Campuses Best Practices Clearinghouse;
  • Track progress toward school reopening and the use of federal funds; and
  • Support learning – no matter the setting.

Next week: details about Goal 6 – Protect those more at risk and advance equity, including across racial, ethnic and rural/urban lines.

 222. A key Issue has surfaced with vaccination scheduling – before March 1, 2021

         Q. Has anything changed since last week on the vaccination program?

         A. An announcement made by governor Lamont over a week ago has resulted in some controversy. Nationally, the CDC recommended the states follow a uniform guideline for scheduling groups to sequentially open their eligibility for vaccinations.  The first several groups were identified with discrete groups:  hospital workers, nursing homes, firefighters, police officers, etc.  This was followed by age criteria – age over 75, and later over age 65.  The Governor and the state COVID advisory committee reviewed the remaining groups such as individuals with identified health conditions, and “essential workers” at various locations.  It is suspected there was concern about how these individuals could prove their eligibility.  Hospital workers and firefighters can be vaccinated at their facilities.  Age can be proved by a state ID or driver’s license.  But how does a bus driver or a person with multiple sclerosis demonstrate their qualifications?  How easy might it be for a healthy unemployed person wanting a vaccination to “jump the line” and simply, falsely, claim an eligible condition?  This raises the need to find a better way to clarify each individual’s eligibility to apply for an appointment.  The state has the authority to decide the eligibility requirements for vaccinations.  The decision was reached to ignore the CDC suggestion and substitute a continuation of grouping people by decreasing age.  An examination showed a correlation of the numbers of people with relevant health conditions decreasing with decreasing age.   So the age criteria were announced and are now in place: ages 55 and over – starting March 1; ages 45 and over – starting March 22; ages 35 and over – starting April 12, and ages 16 and over – starting May 3.

For months, those who are young but who have a relevant health condition, or who work in an essential job such as bagging groceries, were expecting to become vaccinated in just a few days.  Now they are told it may be months or longer before they can find this protection.  Their shared expectations were suddenly changed.  The resulting unpredictability has resulted in protests, anger and frustration.  Controversy is evident and becoming more vocal over time.  The problem now is should the governor  change back to the CDC guidelines, everyone in the now-designated age groups would be made upset because their expectations would become unpredictable.  The “lesson learned” is that for future planning, time must be taken to identify alternatives early, then create expectations that will be more likely to remain in place.

223. Clarification of the goal of vaccination – to prevent serious disease and death.

         Q:  Which of now 3 approved vaccines should I take?

         A:  There is much debate about which of the three now-approved vaccines are the most effective, hence which should I want to receive?   Part of this discussion is the speculation and emerging (but not yet conclusive) evidence on how each of the three vaccines affect the growing number of variant COVID-19 cases.  There is a current consensus of scientists and epidemiologists that once you are eligible, you should get the first vaccine that is offered.  In fact, at any vaccination site, there is only one choice available – the vaccine that is available at that site.  Any delay waiting to find a site that has your “favorite” choice only delays the point where the number of infected people become low enough to slow the number of emerging mutants or variants to reduce this as an issue.  Most people want to become vaccinated so they won’t become Ill.  But we already have been told that many vaccinated people may become infected, yet remain asymptomatic.  They can still spread the disease to others.  This concept is now being expanded to refine the message: the goal of vaccinations is not to prevent one from becoming infected, it is to prevent one from becoming seriously ill, i.e., hospitalized, requiring a ventilator or becoming a fatality.  All three vaccines have clearly demonstrated the same high degree of efficiency in achieving that goal.

224. “Booster shots may be required for some people to continue COVID immunity.

         Q:  Will we have to get annual booster shots for COVID like we do for the seasonal flu?

         A:  This is a possibility, but remains a decision to be made in the future.  The science behind the rapid creation of the Pfizer and Moderna vaccines is based on creating a partial sample of the COVID-19 ribonuclear acid.  That partial sample is not able to replicate itself to spread infections to other cells, but is a memory of the whole (mRNA) that can stimulate the body’s immune system to destroy future complete and infectious coronavirus-19 varioles.  As coronavirus cells mutate, scientists can now identify any of the RNA that may have changed, and create modified mRNA to be readily included in updated vaccines.  In fact, some of these modified mRNA fragments are already being incorporated in the vaccines currently being produced.  Once the pandemic is under control, the possibility exists that variants will then be present that are found to reduce the effectiveness of the mRNA (Pfizer and Moderna) vaccines.  It also may be found that immunity may become reduced over time.  If so, development of a “booster shot” can easily be developed and deployed to sustain the current effort underway.

225. CDC guidance is pending on safe practices for vaccinated people.

         Q:  My friend and I just finished our vaccination shots.  He wants me to travel and “return to normal” with him.  What do I tell him?

         A:  It remains the CDC guidance that anyone recently vaccinated must continue to take the same basic precautions: wear a mask, keep socially distant from others, and wash hands often.  Remember, it is still possible for a vaccinated person to become infected, and without symptoms, pass the disease along to others.  But the CDC is aware that more specific guidance is needed as more and more people are become vaccinated and tempted to relax their vigilance.  The CDC has just announced new and expanded guidelines are being created, and will be released very soon.  It will be wise to follow their advice to be patient and wait before assuming that for each vaccinated person, the long wait is over.

Frequently Asked Questions about COVID-19 — February 24, 2021

  “Shared expectations lead to predictability.”

216. National COVID-19 Strategic Plan – (Part 5 of 8)

        Q:  What’s in the new United States strategic plan for controlling this pandemic?

        A: On January 21, 2021, Joe Biden released the 198-page National Strategy for the COVID-19 Response and Pandemic Preparedness.  This week’s summary gives details about

Goal 4 – Expand emergency relief and exercise the Defense Production Act

The Strategic Plan states: “It’s past time to fix America’s COVID-response supply shortage problems for good.  The United States will immediately address urgent supply gaps, which will require monitoring and strengthening supply chains, while also steering the distribution of supplies to areas with the greatest need.”  To expand emergency relief and strengthen the supply chain, the government will:

  • Increase emergency funding to the states and bolster the Federal Emergency Management Agency (FEMA) response;
  • Fill supply shortfalls by invoking the Defense Production Act (DPA);
  • Identify and solve the urgent COVID-19 related supply gaps and strengthen that supply chain. Included is increased domestic manufacturing of:
    • Antigen and molecular-based testing;
    • PPE and durable medical equipment;
    • Vaccine development and manufacturing;
    • Therapeutics and key drugs;
  • Secure the pandemic supply chain and create a manufacturing base in the US;
  • Improve distribution and expand availability of critical materials.

Next week: details about Goal 5 – Safely reopen schools, businesses, and travel, while protecting workers.

217. Issues with vaccination delivery – as of February 22 2021

        Q. Has anything changed since last week on the vaccination program?

        A. There is an increasing number of vaccination sites opening up. Past problems identifying a site and making an appointment are gradually becoming less frustrating.  Still a problem is the lack of coordination between clinics.  A person can schedule an appointment in three weeks with a clinic they have just called, while a nearer clinic might have an opening in just two days.

Attention is now shifting to the issue of “equity.”  Not all groups are equally able to schedule appointments, or attend vaccination clinics.  Many living in poverty may not have a computer or phone to schedule an appointment.  Those without cars are unable to get to a distant clinic not on a bus route.   And for many minorities, there is the cultural problem of resistance to be vaccinated.  For people of color, there is the lingering legacy of the “Tuskegee Experiment.”  Starting in 1933, 600 men agreed to participate in a study of the treatment of syphilis.  The participants gave their consent without being informed, and proper treatment was not offered.  This lasted for 40 years before it was exposed as an illegitimate effort.  To this day, distrust of the government and of public health practices have remained a formidable barrier for many Black people.   And then, there is the very vocal and expanding “Anti-Vax” movement.

These emerging problems foretell of future intensive efforts to provide multiple vaccination clinics closer to where people live.  Also, on the near horizon will be major public education campaigns to encourage people to receive their COVID-19 vaccinations.

218. In Connecticut, religious exemptions from vaccinations are controversial.

        Q:  Why is the law granting religious exemptions for vaccinations raising such concern?

        A:  State law in Connecticut requires children to be vaccinated against several infectious diseases such as measles.  Those not vaccinated cannot be enrolled in schools unless they have received an approved exception.  Currently, there are two allowable exceptions: a medical condition, given by a physician, where a vaccination could cause harm, and a religious exemption declared by the parents.  Many people don’t want their children vaccinated for a variety of reasons.  Even if the parents don’t hold religious beliefs against vaccinations, it is easy for them to sign the religious exemption form – no verification is required.  The legislature has proposed a bill to eliminate this religious exception.  Literally over a thousand people had signed up to speak at the hearing last week.

This all illustrates the lack of awareness of public health being different from individual or private medical care.  Everyone has the right to refuse medical care for themselves.  Even when this offered care is known to be life-saving.  But the public health is focused on the protection of the population, protection from being infected and being made sick.  Any person who is or could become infected should not be allowed to refuse the public health remedy of being quarantined or being vaccinated to protect others.   For years in Connecticut, people wanting to prevent their children from being vaccinated for any reason have been able to sign a religious objection form.  As a result, many children attend schools without their vaccinations.  A few years ago, a measles outbreak occurred in schools as a result of this.  With the vaccination of children just months away, many are concerned that if parents use this exemption, COVID could spread in the schools.  Other parents want to defend the exemptions.  So the public reacted by attending the hearing.

After 24 hours and 230 speakers had testified, the hearing ended.  Further oral testimony from the 1,730 others who had signed up was denied.  It will be interesting to watch how this debate will decide between what people want and what public health requires.

219. Children will have to wait before they can be vaccinated.

        Q:  When can my 8-year-old child get vaccinated?

        A:  Children under the age of 16 are not yet on the schedule for COVID-19 vaccinations.  (For the Moderna vaccine, the cut off is under the age of 18.)  During the clinical trials of the already approved vaccines, children under these ages were not included.  One major reason for this is the well-known quandary of pediatric medicine: how can parents subject their children to clinical trials of a medicine that has not yet been proven safe?  The FDA requires that vaccines used on children must be first tested on children.  Children at different ages have maturing immune systems that react differently and thus can become unpredictable unless they are evaluated.  The clinical trials in adults provides confidence that new clinical trials can now proceed to verify their safety and efficacy, and to establish dosing guidelines for children.  It was decided to first focus on adolescents because they make up 67% of actual cases, while children ages 5-11 make up only 37%.

COVID-19 does affect children.  Even though the number of pediatric COVID cases are fewer than for adults, as of February 11, up to 2.3 percent of the more than three million children who have tested positive have been hospitalized.  At least 241 children have died from the disease.  It can be assumed the vaccine can help control the infection in children and reduce the ability to spread the disease to others.  It is not yet known what the vaccine’s effect is on the Multisystem Inflammatory Syndrome that often occurs in pediatric patients.  Evaluations are already underway with Pfizer testing its vaccine on 2,500 children between the ages of 12 and 15.  Moderna is enrolling 3,000 participants ages 12 to 17.  Results on these teenagers should be known by this summer – Dr. Fauci recently projected this is possible as early as April.  He also stated studies on younger children will follow with results hopefully by September.    But many variables could cause delays.

220. The personal impact of a shortened life span – what it means for you

         Q:  I hear that COVID-19 has shortened life span by 1 year.  Will we will all die earlier?

         A:  It was announced last week that because of COVID-19, the estimated life span is now one year less than it was last year.  This is another statistic publicized to add drama to the impact of the disease. Unfortunately, it is causing concern because it has not been fully explained.  A life span is an average calculation – a number which includes the group as a whole.  It cannot be applied to one individual.  For example, if a program to have people stop smoking succeeds, those who never smoked can be expected to live just as long as they would have earlier.  But the average life span for everyone together would increase.

The number of deaths in the U.S. from COVID-19 has steadily increased over the past year.  Many of these deaths have been younger people who previously would have died much later from other causes.  The average length of life for the group has thus been shortened.  Those who were never ill with COVID can expect to live just as long as they did before.  Over time, as the pandemic wanes, fewer younger people will be dying from COVID.  The continuing calculation of life span will then increase.  The pandemic deaths will later be offset by people living in a much healthier future world.

Frequently Asked Questions about COVID-19, February 17, 2021

  “Shared expectations lead to predictability.”

210. National COVID-19 Strategic Plan – (Part 4 of 8)

        Q:  What’s in the new United States strategic plan for controlling this pandemic?

        A: On January 21, 2021, Joe Biden released the 198-page National Strategy for the COVID-19 Response and Pandemic Preparedness.  This week’s summary gives details about

Goal 3 – Mitigate spread through expanding
masking, testing, treatment, data, workforce,
and clear public health standards

 

The Strategic Plan states: “A comprehensive national public health effort to control the virus – even after the vaccination program ramps up – will be essential to saving lives and restoring activity.”  To achieve this, the United States will:”

  • Implement masking nationwide by working with state and local officials and people;
  • Scale and expand testing;
  • Effectively distribute tests and expand access to testing;
  • Create new therapeutics, treatment development programs and drug prioritization.
  • Develop actionable, evidence-based public health guidance;
  • Expand the US public health workforce and increase clinical care capacity;
  • Improve data to guide the response to COVID-19.

Next week:  Details about Goal 4 – Expand emergency relief and exercise the Defense Production Act.

 211. Issues with vaccination registration – as of February 15, 2021

         Q. Has anything changed since last week on the vaccination program?

         A. The previous methods to track eligibility for vaccination and to make appointments remain the same. These are now broadly published by the news media.  The wide-spread confusion and waiting times are slowly being reduced.  “Be patient and persistent!” is generally good advice to follow.  A new nation-wide NBC website was released last week designed to centralize the process.  This “Plan Your Vaccine” is located at:[1]   

https://www.nbcnews.com/specials/plan-your-vaccine/

This release was just a short time ago.  Its  usefulness has yet to be evaluated by public feedback.

212. CDC guidelines issued for school reopenings

         Q:  Have the promised school opening guidelines been released by the CDC?

         A:  Yes.  Previous statements that studies and data indicated it would now be safe to reopen primary schools (K-12) met with controversy and concern.  In reaction to this confusion, the recommendation that schools should open soon was delayed until the CDC provided guidelines to make schools safe.  This was yet another illustration that expectations need to be shared to allow decisions to become predictable.  On February 11, 2021, CDC published the promised guidelines as “considerations” for operating schools safely during the COVID-19 pandemic. It was stated that these are not “mandates” nor “requirements.”  They offer guidance for school officials, staff and parents in reaching a decision to reopen.

Any local decision to open and remain open should be based on measuring the benefits of achieving educational goals with in-person teaching against the risk of infecting children, teachers and staff.  This CDC document offers mitigating “considerations” for review.

These new guidelines are quite detailed.  “Taking actions to reduce the spread of the virus that causes COVID-19” takes up most of the 16-page CDC document.  The discussion centers on mitigation and reduction of risk.  It is broadly recommended that every school should have a written “Emergency Operations Plan” (EOP).  Such a plan should address in detail the following;

  • Promoting behavior that reduces risk including masks and social distancing;
  • Adequate supplies including PPE, hand sanitizer, and no-touch trashcans;
  • Healthy environments including regular cleaning, and adequate ventilation:
  • Healthy operations including considerations for at-risk staff, and splitting schedules;
  • Preparations for when someone becomes sick including care and transportation;
  • Considerations for students with disabilities and special healthcare needs.

After release, the immediate reaction to these guidelines was concern over the costs and delays to implement many of these considerations.  Ventilation and expanding space to permit social distancing are cited.  These guidelines go beyond the current need, which is to reopen schools quickly.  In addition, it is noted that testing is not included, which is seen by most authorities as essential to identify asymptomatic patients.

Every school in Connecticut is mandated to have a written emergency operations plan.  Evaluation and approval of each school’s plan is done annually by the state Department of Emergency Management and Homeland Security (DEMHS).  Because any modification of a plan is usually scheduled on an annual basis before it’s review, no  plans have yet been updated to include these new CDC guidelines.  However, every school should be rapidly preparing draft COVID policies and procedures, including these new considerations, attached to their plans.  Concerned parents might want to review their school’s EOP plan and policies to ensure it is updated.  To compare a school plan’s details against the CDC considerations, anyone can obtain a complete copy of the new CDC guidelines at:1

Operating schools during COVID-19: CDC’s Considerations

_____________________

[1] To open this website, copy the entire URL (the underlined letters in blue and copy this in your browser.

213. Teacher vaccines are not required before schools reopen

         Q:  Are teacher vaccinations required in the new CDC school reopening guidelines?

         A:  Teacher vaccination is the latest state-wide hot spot of controversy with COVID-19 mitigation.   Many people everywhere are clamoring to become eligible so they can quickly get their shots.  Teachers in Connecticut are in a group that has yet to become eligible.  There is a perception that continuous lengthy indoor classes with numbers of people not living in a teachers’ household, places them at high risk.  The recently released CDC guidelines make no mention of vaccinating anyone in a school before reopening.  Rochelle Walensky, MD, director of CDC stated earlier that teacher vaccinations are “important but not a prerequisite” for schools to reopen.  She explained that science finds that people are at greater risk of contracting COVID-19 in their community than in their schools.  Reducing COVID in the community would reduce risk in schools.  The perceptions of teacher unions and school boards do not agree with this.  Teachers feel threatened by returning to the classrooms unvaccinated.  Many threaten to refuse to return until they are vaccinated.  As early as mid-January, governors in Arizona, Ohio, Utah and other states had moved up the eligibility for teachers and school staff to become vaccinated. Most of them now have received their shots.  Perhaps governor Lamont could easily do the same.  In any event, as more vaccine doses become available, school staff will soon be in an eligible group.

214. New CDC guideline: no quarantine required for vaccinated people

        Q:  Are people exposed to COVID  required to stay in quarantine?

        A:  Currently, there are no requirements that people who may have been exposed to someone with COVID-19 must be quarantined.  Statutes exist that could require this for exposure to any infectious disease when ordered by the governor.  COVID-19 has so many people possibly exposed that such a mandate would create chaos and invite violations.  But today, there is one situation where it is not recommended that someone quarantine.  The CDC last week issued the guidance that anyone who has been fully vaccinated (by completing their second dose of the Pfizer or Moderna vaccine) need not quarantine if they come in contact with someone who has contracted COVID-19.

215. Caution issued: don’t copy, post or share your vaccination card

        Q:  I want to tell people I am vaccinated. Why shouldn’t I post my card on Facebook?

        A:  To encourage others to become vaccinated, many people were initially advised to tell friends and family they’ve gotten their shots, or post their card on social media, or send copies via e-mail.  The Better Business Bureau and several credit security agencies now caution against this.  Each vaccination card has personal information such as name and birthdate.  Scammers are everywhere looking for copies of this very familiar card to capture its information.  One scam is to copy your card and print duplicate phonies that could be sold.  Instead, the BBB recommends photographing your vaccine sticker – it doesn’t have any personal information.

[1] To open this website, copy the entire URL (the underlined letters in blue and copy this in your browser.