COVID-19 Update 9/3/21

The following is a summary of significant updates and studies that have been recently released. It is important to keep in mind that data and scientific understanding is constantly evolving.

The Pfizer vaccine is now approved for 16 year olds and older. EUA still in place for individuals 12–15yo. The vaccine will be marketed under the name “Comirnaty”.

A study looked at 43,000 cases of varying severity in LA country between May and June 2021 and determined 71% of cases were in unvaccinated and 25% in fully vaccinated. In this study unvaccinated individuals were 4.9x more likely to get infected and 29.2x more likely to end up hospitalized. The point is that vaccinated people can still get infected, hospitalized and even die from COVID-19, but the risk is greatly reduced when vaccinated.

Between May and July 93% of all people hospitalized with COVID-19 were unvaccinated. The average out of pocket expense was $1,300.

In a small study of healthcare workers infected with COVID-19 the amount of virus decreased more significantly in the first 3 days of illness vs. those that were not vaccinated. The conclusion was that viral shedding was lower in vaccinated infected individuals vs. infected unvaccinated individuals. This is also validated by the larger Singapore study.

Data is still evolving from the 3rd booster shot. Evidence out of Israel and small studies in the states are showing a good safety signal. Levels of neutralizing antibodies are increased, it is being inferred this offers disease protection, but studies are still ongoing to understand how robust this is and for how long it offers protection from severe disease.

Studies are still ongoing and data is evolving regarding the differences in immune protection from natural infection vs. vaccination. Waining immunity is being observed in both groups, however the difference between the groups is a point of interest. In people with natural infection they seem to have an increased reinfection rate at six months which appears to be twice the risk of reinfection of vaccinated individuals at six months. There is not yet enough data about the severity of infection amongst those two groups.

Data from several states are showing that 1 in 50 pediatric cases are resulting in hospitalization, or 2.2% hospitalization rate. mortality rate is 1/10,000. Phase 2/3 vaccine trials for under 12 is still ongoing. however it’s important to note in the last two weeks they have been 47 pediatric death compared to 349 cumulative deaths since January 2020. so this mortality rate is likely evolving in the era of the Delta variant.

A Chinese study that ran for six months looked at 730 COVID-19 cases and over 8,000 close contacts. It was determined that the risk of transmitting SARS CoV2 was higher 2 days prior to symptom onset or 3 days after onset. Risk of transmission was higher in mild to moderate infection vs. asymptomatic.

The most effective treatment for people with severe COVID-19 infection continues to be monoclonal antibody therapy in the right group of patients and early in hospitalization. Ivermectin is not recommended for use in COVID-19 patients as harms continue to outweigh benefits. Vaccination continues to be our best tool in combating the pandemic worldwide.

The US is currently reporting 160k cases/day which is 4x the amount this day last year. 101k are currently admitted to the hospital for COVID-19, of those 26k are in the ICU. On average 1,350 Americans are dying from COVID-19 daily. 9.4k have died in last week. In the entire month of July 8.5k died which shows the trend upward in mortality. Several states are reporting less than 10% ICU bed capacity.

There is a growing scientific consensus that the old models of prediction and policy are no longer as valid with the Delta variant. This possibly applies to the CDC’s definition of close contacts being someone who is within 6 feet of a confirmed case for more than 15 minutes in a 24 hour period. Predictive modeling for masking and general infectivity that was done under the Alpha variant is also now being challenged as inaccurate in terms of the Delta variant.

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