Coming Down The Homestretch

Today we will present some promising news with respect to current disease burden and trends.  We will also present some caution in looking at those numbers as we project forward.  Lastly, we have a little discussion about the vaccines available, their safety, and the national and local ability to deliver them.  Oh yeah, some tunes for a snow day as well.

“If you’re looking for examples to refer to

Take a look around yourself, I’m sure you’ll find

There are many things to make your life much brighter

And I bet there’s many more inside your mind”

Terry Reid and Graham Nash (Crosby, Stills, and Nash: Horses Through a Rainstorm, 1991)

A little Metallica, The Four Horsemen, off one of their earlier albums, Kill ‘Em All.  Just to get your pulse up a bit.

Color By Numbers

Nationally the number of cases is again significantly lower this week.  We have not seen daily case numbers this low since the middle of November.  This is obviously very exciting to most of us.  Before you go jumping around for joy though, keep in mind there are 160,000 new cases per day still being reported.  Prior to October, the daily numbers were in the 30-50,000 per day range, so we are still dealing with A LOT of sick people. The current death rate is still at the peak at nearly 4,000 deaths per day, but this is a lagging indicator, and one would expect to start seeing these numbers decline over the next few weeks.

The local picture is similar to the national picture.  The number of cases in Suffolk County is clearly lower than prior weeks.  The percentage of folks tested that are swabbing positive is also lower.  Hospitalizations are starting to finally decline, and would soon expect the death rate to start lowering as well.  Again, before getting too excited, the disease burden is still quite high locally.  We are still seeing about 1300 cases per day as opposed to less than 200 per day at Halloween.  The percent positive rate is still close to 7% which is down from 10.5%, but still much higher than the under 1% at Halloween.  There are still slightly over 700 hospitalized in Suffolk County.  This is down from about 850 a couple of weeks ago, but much more than the 25-30 we were seeing around Halloween.  There are still double digits deaths daily in Suffolk.

In summary, there is much to be encouraged about.  The current wave seems to be well on the downslope.  This is not a cause yet though for celebration.  The disease burden is quite significant.  The issue is that everyone has gotten a bit numb to the catastrophe.  Six months ago, you would have freaked out seeing these numbers.

While on the topic of things that spread like wildfire, this mid 70’s tune from Michael Martin Murphy seemed to fit

A Brief Vaccine Update

The Tools We Have

Both the Moderna and Pfizer vaccines are currently being administered in the United States under Emergency Use Authorization.  Both continue to demonstrate a strong safety profile.  There are case reports in the news that certainly scare everyone, as nobody feels comfortable when they see a headline such as “Joe died 12 hours after his vaccine.”  The reality of the situation though is that there have only been a couple of such reports among the millions of doses delivered.  Being that your chance of dying from COVID this year was roughly 1 in 800, a 1 in a million chance of being killed by the vaccine is a no-brainer.

Johnson and Johnson reported data over the last week also showing a strong protective response from their vaccine and without significant safety concerns.  Expect that this vaccine will be added to our Emergency Authorization Usage repertoire over the next few weeks.  Many will discount this vaccine as it only showed roughly 65% efficacy as opposed to the greater than 90% of the Moderna and Pfizer vaccines.  However, the studies were based on using a single dose.  The data for those getting a single dose of Moderna or Pfizer vaccines was comparable.  Perhaps at some point they will add a booster dose.  For now, it means we have another tool in our armament to get the disease burden lower in the immediate term.  When your time comes to get a vaccine, follow the old adage of “you get what you get and don’t get upset.”  If you can lower your risk by two thirds with a single, stick you arm out and say “Thank you!” You can always seek booster doses or getting another version of a vaccine later.

At this time, there is still nothing new to report about vaccinating our youth.  There are trials underway, but as kids are not micro sized adults when it comes to medications and vaccines, we will let the data speak once it is acquired and available to review.

Did you think you would make it more than a week or two without a little Zappa?  Today’s offering is a live version of the instrumental tune, The Deathless Horsie, from SUNY Stony Brook in 1984.  Let’s hope the vaccine leads to deathless humans courtesy of an effective immunizations program.  

Supply Chain Revisited

There are clearly still significant supply chain issues affecting getting everybody vaccinated.  Some of the downstream constraints appear to have been worked through since the last blog and nearly all of the state allocations have been finding their way into the arms of the high risk groups that are eligible to receive them at this time.  The federal government appears at this time to be trying to increase weekly allocations from its stockpile to ease that constraint.  The manufacturers are also working to increase supply, and they are likely to be the most significant bottleneck in the process.

There are new variants emerging continuously.  No fancy names for them.  Kinda like a Horse with No Name, another 70’s horsey tune for you today.  Honorable mention to the Stones, Wild Horses here.

Mutants

Many have been following the news about novel variants of COVID-19 emerging.  This is not surprising considering the numbers of affected individuals.  Mutations occur due to errors in replication.  The error rate is fairly consistent and predictable.  The more times you make copies, the more likely you will make an error.  This is not unlike any task you have performed in your life.  Even Michael Jordan got posterized every now and again (by John Starks for example).

Mutations are not always good nor bad, it depends what you select for.  Take Brassica oleracea for example.  It is the progenitor of broccoli and a litany of other of your common veggies.  All courtesy of selective breeding.  Selective breeding also permitted orcs that can tolerate daylight in Lord of The Rings and is why regulation of such is often deemed necessary.  When it comes to COVID-19, what we do not wish to see are much faster spreading variants, much more lethal variants, or variants that evade the protection offered by existing vaccines.  Some of these are already emerging, and are of significant concern.

The current vaccines at this time continue to possess benefit for the emerging strains, albeit to varying degrees.  On a positive note with respect to evading protection offered by existing vaccines, the technologic advances in making vaccines are such that the manufacturers believe they can create updated vaccines for emerging strains in under 100 days.

Went with Aerosmith, Back in the Saddle, considering the audience.  If you seek some old school country however, check out a song by nearly the same name from Gene Autry.

Back In The Saddle Again

At this time, we appear to be progressing well in the battle against COVID-19.  The current wave of disease is dissipating.  Vaccines are being rolled out by the millions.  Technology is preparing in advance for expected viral variants.  Our immediate term task is simple.  Continue to push vaccine roll out as fast as possible.  Continue to mask and social distance.  We are in the homestretch.  Please do not let your guard down, you have made it this far already.  Besides, it makes emerging variants more common, something society is preparing for but would rather not deal with.  I personally am very much looking forward to a reasonably normal summer.  I am wagering you all share a common vision.  See, Americans can agree on something.

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.