56th Update on Corona Virus Pandemic with Dr Peter
Some Review of Transmission Rates
Does the new variant, with a higher transmission rate, matter?
The transmission rate of a virus matters a lot. When the virus hit, it seemed to have an R0 (R-naught) of 3.0 – meaning one person would most likely transmit it to 3 other people. This is a relatively high transmission rate. The measures we take (distancing, masks, etc) are really to break the chain of transmission. The R0 is a variable number and taking measures can drive the R0 down. It has gone down closer to 1.0.
The new variant that came up in the UK (B 117) is now being found in the US in people who have not traveled. The transmission rate is 50 – 70% higher in the variant. We know that where this variant takes hold it becomes the dominant strain in the community.
It was found first in SE England and within 3 months is over 70% of the cases that are being found.
When there is a virus that increases exponentially, the transmission rate matters. The higher the transmission rate, the more explosively the virus ends up doubling and expanding to more people. We don’t easily comprehend exponential explosions – we think more linearly.
Remember the explanation that Dr Peter has used: case-case-case-CLUSTER and then cluster-cluster-EXPLOSION
The vaccinations do help transmission rate and the R0 – there are fewer people the virus can get to.
But if the transmission rate is suddenly higher (as it is with the variant), it can be a real battle to keep up the measures to hold the R0 down and prevent a huge explosion of cases. This is the concern in the medical community. The variant can have a real affect on the cases, the hospitals, the economy.
Recall the illustration Dr Peter used in the past: Sitting in a large stadium at the top tier, looking down on the field. A single drop of water is placed in the field. The amount of water will double every minute. After one minute, there are two drops, after two minutes there are 4 drops, after three minutes, 8 drops, etc… Will the game be able to be played before the water covers the field? After 45 minutes the field is covered and the water is coming to the staircase that leads up to the seats. When should we leave? The entire stadium will be filled to the top in another 4 minutes.
This is the nature of exponential growth.
An interesting question: Would you rather have a mutation where the R0 is the same, but it is 50% more deadly – or – would you like a 50% increase in transmission rate with a fatality rate that is the same?
Looking at the question and thinking – “Oh good, it’s only the transmission rate that is different, it’s not more deadly.” may not be the best way to look at it.
Right now, in European cities, the R0 for Sars II Corona Virus is about 1.1 (one individual can pass it to 1 other person). The case fatality rate is pretty low at 0.8%.
Example: 10,000 infections. After one month there would be about 130 deaths. (This number is found by multiplying 10,000 X 0.8 = 80. Add 50 more deaths from additional infected cases that go on to die.) If the fatality rate goes up 50%, that means 50% more mortality and about 200 deaths.
If the R0 goes up 50%, and the fatality rate stays the same – there would be many more cases and about 1000 deaths after 1 month.
Higher transmission means more cases, more hospital admissions and possible overwhelm of the hospital systems – requiring draconian (severe) restrictions and possible economic collapse.
The R0 right now is about 1.1 – 1.2 with the restrictions we have in place.
A tiny change in the R0 can have a huge effect on the number of cases.
R0 of 1.0 and an initial 1000 cases. In 60 days we will have 12,500 cases
R0 of 1.1 and an initial 1000 cases. In 60 days we will have 25,000 cases
Just a tiny change in transmission rate will yield a big impact on cases in a 60 day period.
The next 2 months may be challenging and we may want to look at vaccination as a way to drive down the R0.
Statistics (2 weeks since the last update)
Nevada County (about 100k pop)
2700 cases, up 500 cases from 2 weeks ago.
Case Positivity Rate: An average daily positivity rate (over 14 days): 14.3% Two weeks after Thanksgiving it was 20.1% Would be good to see it at 6%
About 250 PCR tests done per day. Also antigen tests, but don’t know how many. Only positive results get reported – don’t know how many negative ones are being done.
17 people hospitalized for COVID 19, down from 20. ICU cases about the same at 5.
Deaths in county: 50, up from 39. Probably closer to 70 because people have been transferred.
Case Fatality rate: 2.5%
291 cases in the 95959 zip code, where Ananda Village is located.
Sierra County (3100 pop)
47 cases, up from 32
Hospitalizations: 0 No deaths
Case positivity rate averaged over 14 days is 9.4% up from 3.4% three weeks ago
Yuba County (80Kpop)
3900 cases up from 3200 Hospitalized: 81 up from 57, ICU 20, up from 12
CPR: Averaged over 14 days is 19.3% (down a bit)
Deaths: 19, up from 15
Placer County (400Kpop)
14,000cases, up from 11,3002 wks ago
CPR: 14 day average is 12.9% down from 17% 2 wks ago
Hospitalized: 200, same ICU: 33 up from 31
NC: 2700 cases per 100K pop
Sierra: 1500 cases per 100K pop
Placer: 3600 cases per 100K
Yuba: 5000 per 100K pop
California: 6200 per 100K pop
*Oregon: 2792 (added by LK)
*Washington: 3354 (added by LK)
US: 6400 per 100K pop
States – Deaths per 100K
CA: 67 per 100K
NJ: over 218
*OR: 35 (added by LK)
*WA: 45 (added by LK)
Countries – deaths per 100K
Belgium: 170 deaths per 100K
California (40 million pop)
2.5 million cases, up from 2 million cases 2 wks ago
CPR: Averaged over 14 days: 12.3%, steady
Deaths: 23K up from 20K
Hospitalizations: 22,000, up from 18,000 ICU 4700, up from 3700
Cases per day: 40,000
US (330 mill pop)
21 million cases, up from 18 million (error in last week’s report)
30,000 in critical care, up from 28,000 2 weeks ago (a huge strain – doubled in 3 months, no additional staffing)
Cases per day: high of 240K a few days ago
CPR: 11% stable
Deaths: 360,000 Deaths daily: 2000
Mexico (130 million pop)
1.4mil cases up from 1.3 million
Lack of testing: only 3 million tests (US has done over 200 million)
CPR: 40% still (testing is very poor)
CFR: 9% same
Deaths: 130,000 up from 120K
India (1.3 billion pop)
10.3 mil cases – up from 10 mil
Deaths: 150,000 up from 145,000
Public Health Department Updates from last 2 weeks
Reminder that the typical time frame after a holiday with people traveling and congregating:
2 weeks after there is an explosion of cases (look at around Jan 10)
2 weeks after that there is an explosion of hospital cases (look at Jan 25)
2 weeks after that is when we see deaths increase (Feb 10)
Some additional surge will happen probably as a result of New Year’s travel
CVS and Walgreen’s will be carrying the vaccine. Elderly and those in nursing homes are being vaccinated now, along with staff. This is optional and only about half of staff are choosing to be vaccinated at this time. Hopefully this will increase.
Hospital staff are getting the vaccine as well – about half are choosing to do so.
You CAN get the vaccine if you have had Covid 19. It will help protect you in future – it’s a different kind of immunity.
Pfizer and Moderna vaccines are approved. The Astrazeneca vaccine will be approved soon in US, being given in Britain. Dr Peter’s clinic will be giving the Moderna vaccine.
Severe reactions are extremely low (1 in 200,000) Stay around after getting the vaccine to make sure you are not one of the very rare ones. One treatment is usually all it takes to treat a reaction.
When is immunity in full force after getting the vaccines? Both Moderna (28 days between doses) and Pfizer (21 days between doses) are given in two doses. Antibody levels are at peak about 2 weeks after the second shot. Probably about 6 weeks after the first shot.
Of course – even those who have received vaccine should continue to practice all the precautions and safety behaviors to help keep the R0 down. Not clear now when we will be able to relax a little on those safety measures as the vaccine is given out. Perhaps end of summer, probably not until late fall.
Long term (long haulers) symptoms from Covid 19 are significant. About 10 – 20% of people have long range symptoms.
PCR testing only offered through medical practices. Takes 2-7 days to come back.
Antigen testing (rapid tests) offered in Dr offices and take about 20 minutes. At home versions will be available soon. Cost about $30. Two kinds will need Dr Rx and one will be available OTC. Big problem with at home testing is people testing positive and not doing anything about it.
Big public health focus will be on getting vaccines out to medical personnel. Contact tracing is not happening right now, except through the medical practitioner. Public health dept does not have time to deal with contact tracing.
Monclonal and Polyclonal Antibody Treatments
Now 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.
Hospitals at Folsom and Mercy San Juan are full. Sending cases up north.
End of Public Health update
Dr Peter will be doing a “special” about the vaccines when we get closer to having vaccines more generally available. They will have them at their clinic this month for those who qualify.
Roll out is going a bit slower than hoped. About 50% of people are declining. They are learning that giving half doses results in very nearly the same immunity and it could mean being able to give it to more people.
You get about 80% of your immunity from the first dose. They may delay the second doses and work on getting more people on the first dose to try and keep the R0 down.
Need about 350 million doses if about half of people in US want it.
Dr Peter feels it is possible that a lot more people will want the vaccine after we go through the surge that is coming post holiday. It will be “stunning”.
Who should get the vaccine?
Easiest recommendation is for those older than 65. More serious illness and deaths are in older population. Risk to benefit ratio is in favor of vaccinations for that group.
Under 50 with health risks – risks to benefit is also in favor of vaccine.
For 20 year olds – risk may not be great for them, but there is argument for protecting society, keeping the transmission rate down and protecting everyone and creating herd immunity.
Both vaccines are doing studies on teens and children.
Vaccine passports – will we eventually have proof of vaccination to travel or shop or other things? Would not be surprising.
UNITED KINGDOM mutation / B 117
South Africa, B 1317 mutation – very similar to the British one, but not exactly the same.
Higher transmission rate in these mutations. B 117 transmission rate is 50 – 70% higher than the classic Sars II. Also seems to be higher transmission rates in teens and children. This may affect school closures. Even though they just showed up in September, over 60% in UK and 90% of S Africa cases are the mutations.
Some countries are blocking flights now from the UK but it’s already out there. In California they have increased surveillance looking for this strain. All the measures we have been taking to “flatten the curve” and decrease transmission rate are very important and we may have to do more because these mutations are increasing the transmission rate.