55th Update on Corona Virus Pandemic with Dr Peter
12/21/20
Statistics
Nevada County (about 100k pop)
2200 cases, up 600 cases from 2 weeks ago. 40 – 60 per day
Western NC – 1500 cases
Case Positivity Rate: An average daily positivity rate (over 14 days): 15% starting to come down a bit.
Mostly PCR tests, but now the antigen tests, such as BinaxNOW rapid test used at the clinic are gaining use for symptomatic people. Only positive results get reported – don’t know how many negative ones are being done.
Daily range of people hospitalized for COVID 19 has ranged between 14 and 20. 4-5 per day in ICU.
Beds available in ICU (between 2 hospitals) range between 1-4 beds per day. Has been 0 at times.
Deaths in county: 39, up from 16 Usually deaths are undercounted because if someone is sent outside of the county for treatment the death is counted in the county where they died.
Case Fatality rate: 2.3%
Sierra County (3100 pop)
32 cases, up from 24
Hospitalizations: 2 No deaths
Case positivity rate averaged over 14 days is 7.9% up from 3.8%
Yuba County (80Kpop)
3200 cases up from 2400 Hospitalized: 57 up from 16, ICU 12 up from 9
CPR: Averaged over 14 days is 20%
Deaths: 15, up from 11
Sutter County
CPR: Averaged 14 days: 24%
Placer County (400K pop)
11,300 cases, up from 7800 2 wks ago Deaths 74, up from 63
CPR: 14 day average is 15.6% up from 11% 2 wks ago
Hospitalized: 200, up from 60 ICU: 31 up from 29
Auburn Area
Huge jump in cases: 1100, up from 600 2 wks ago
Population statistics
NC: 2200 cases per 100K pop
Sierra: 1000 cases per 100K pop
Placer: 2800 cases per 100K
Yuba: 4000 per 100K pop
California: 4800 per 100K pop
*Oregon: 2456 (added by LK)
*Washington: 2983 (added by LK)
US: 5500 per 100K pop
States – Deaths per 100K
CA: 57 per 100K
NJ: over 200
NY: 190
MA: 170
*OR: 32 (added by LK)
*WA: 41 (added by LK)
Countries – deaths per 100K
Belgium: 160 deaths per 100K
Italy: 114
Peru: 112
US: 98
Mexico: 91
California (40million pop)
2 million cases, up from 1.4 million cases 2 wks ago
CPR: Averaged over 14 days: 12%, up from 8.1%
Deaths: 23K up from 20K
Hospitalizations: 18,000, up from 11,000 ICU 2400
Cases per day: 50,000, up from 15,000
US (330 mill pop)
158million cases, up from 15 million
Over 28,000 in critical care, up from 26,000 3 weeks ago (average daily census)
Cases per day: over 250K
CPR: 11.1% stable in the last week, up from 7.3%
Cases per 100K: 5500
Deaths: 324,000 Deaths daily: 2000 – 3500
Mexico (130 million pop)
1.3mil cases up from 1.2 million (
Lack of testing: only 3 million tests (US has done over 200 million)
CPR: 40% (testing is very poor)
CFR: 9%
Deaths: 120,000 up from 110K
Cases per 100K pop: 900
India
10 mil cases – about the same
Deaths: 145,000 up from 140,000
Public Health Department Updates from last 2 weeks
They have divided the state into five regions and the region for NC and Ananda is called “Greater Sacramento Area”. The region is in “widespread” status. ICU bed availability is about 11%. (Would like to have at least 15% ICU capacity)
Pfizer vaccine: Was received by hospital system in Nevada County last week. First round is for clinical care personnel in the hospitals. CVS pharmacy system is giving out vaccine in nursing homes. Hopefully, everyone in nursing homes or working in nursing homes, and working in hospital systems will receive the vaccine if they want it. Can give to anyone 16 yrs old or older. This one has to be kept at super cold temperatures, which makes shipping problematic.
Moderna vaccine: Not the same requirements for storage. Shipments are happening today.
The next tier of people who will be getting the vaccine are teachers, first responders, grocery clerks, people over 75 – this group represents over 50 million people (about 15% of the population).
Travel
Vaccination may be required for travel. Airlines are saying it will be a requirement. Some health care facilities are saying they may require it for their staff. Some hotel chains are also saying it may be be required. There are legalities that have to be worked out – requiring for employment, etc.
At Home test kits:
Three test kits becoming available. Labcorp, BinaxNOW (like a home pregnancy test), and one other company. Will be available soon. Cost unknown. Some problems with this – not everyone will want to report a positive test, we won’t know how many negative ones are done either. We will lose track of our case positivity rate.
OptimServe site in NC:
Those people without symptoms and no exposure – can do 170 tests per day. Monday – Friday. Going to go to 7 days a week.
Monclonal and Polyclonal Antibody Treatments
Becoming available at the local NC hospital. Generally given to people who are at high risk of being hospitalized. Very effective – gives protection for about 6 weeks.
Testing turnaround time for PCR tests – still longer than optimum. 2-4 days. Rapid Test gives immediate result, but not quite as accurate.
Quarantine after exposure to a known case is still 14 days. Alternative for people that are essential workers and are asymptomatic – can go back to work at 10 days and be very careful. Can shorten to 7 days with a negative test at 5-7 days, then being very cautious for 7 days after that. Chances of being
infectious after 14 days is <1%. With 7 days, we are probably going to miss 10% of cases. California State now has an app that will notify you if you have come near someone else (who has the app) and has tested positive. No personal information is given. Interesting to see where this will go and how helpful it will be – security is an issue. Hospitals are under stress because of slow staffing even more than available beds. Many caregivers are testing positive.
End of Public Health update
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VACCINES
What do we know?
The first two vaccines are called mRNA vaccines. They encourage your own immune cells to create neutralizing antibodies to the spike proteins on the corona virus. The spike protein is what the vaccine is coded to fight against. It is spikes that attach to our human cells and infect the cells. The vaccine is effective in fighting the SARS II Corona virus.
These vaccines have actually been in development for 10 years. The teams working on them were working on vaccines for cancer. There was already quite a bit of background done. We have been using them in humans for less than a year, but there have been testing and background work that goes back much farther than that.
We, as general population, will most likely be offered the Moderna vaccine (the Pfizer vaccine is the one that requires super cold storage).
There are 2 additional vaccines coming. AstraZeneca (developed from a cold virus) and Johnson&Johnson.
The Pfizer and the Moderna vaccines are 2 shot series. The first shot provides most of the immunity you are going to get. The AstraZeneca will also be a 2 shot series. Pfizer vaccine is for 16 yr olds and older. The Moderna is for 18 yrs old and older. Both can be given to pregnant and lactating women. This is a good sign for the safety.
Questions:
1)What are the long term risks? There have been animal testing for years in similar vaccines. But we have not used these long term yet.
2)What about vaccines for children and young teens? Not sure yet
3)How much will this prevent transmission? Not clear. Will prevent people from getting sick with Covid 19 but it isn’t clear about people being asymptomatic and passing the disease on. Some more recent studies looking at asymptomatic transmission show that people who are actually asymptomatic are less likely to pass it on that we originally thought. But being presymptomatic is still a big issue – you can be very contagious before you get symptoms. May encourage college age to take vaccine and see if it affects transmission rates. Have to wait and see.
Acute reactions: Small number of people can have acute reactions that require epinephrine to reverse. Similar to allergy shots and people having to take epinephrine. Everyone has been treated immediately and recovered.
Short term side effects: 1-3 days of low grade fever, muscle aches, will occur in about 10% of people. Any bad reactions – don’t get second dose. Vaccinating health care workers in shifts to avoid having too many people out at the same time.
UNITED KINGDOM mutation
New strain of the virus has 23 mutations compared to the classic SARS II Corona Virus. Showed up in September, near Kent in SE London. About 60% of cases in the UK are of this strain. Also seeing it in South Africa, where it is 90% of cases. Seems to be more transmissable than the classic virus. About 70% more transmissable, but it doesn’t seem to be more deadly. Hospitalizations and deaths are about the same rate as the classic virus.
As far as we can tell, the vaccines will still be effective against this mutation. Some indication that mutations that may be resistant to the vaccine will not occur in short periods of time. The vaccine would probably have to be out for a year or more. But this is not known for sure.
Travel Guidance
Dr Peter notes that he has been asked about 30 times about travel in different circumstances and the answer has always been NO. Do not travel – stay home. Go out for only essential things.
Long Haul Symptoms
Dr Peter’s clinic has had enough cases now that they can see >10% of patients with Covid 19 have “long haul” symptoms. Those are people having significant debilitating symptoms after 8 wks from developing symptoms. One example: a robustly healthy 30 something year old. No risk factors. Very sick with symptoms, but not hospitalized. Has never gotten over it. Severe headaches, fatigue, no sense of smell, unable to work.
Please be aware that it is not a disease anyone wants to get. We don’t know if these people will ever get better.
Q: What is the difference between “breaking the transmission rate” and “keeping people from getting sick”?
A: If we can break transmission, there will be fewer cases and fewer people will get sick. What we don’t know is how much the vaccines will have on the transmission rate. We think it will be high, but we don’t know. We hope to get herd immunity which will make no ability for transmission.
Remember, when you have a more transmissable strain (like the UK mutation) you have to vaccinate more to get herd immunity. Such as measles – you have to vaccinate nearly everyone, over 90%.
Something with a lower transmission rate you may get away with 50 – 60%.