As I’m sure you all know, COVID-19 is spreading across the country in a 2nd or 3rd wave (depending on how one counts the waves) and reaching new highs in terms of test positivity, cases, and the number of deaths.  Hospitals in many areas, especially in the more rural parts of the country, are stretched very thin.  Front-line and supporting health care workers are especially hard hit.

Locally the situation is much the same.  The post-Thanksgiving holiday time, as expected created a further uptick, and this can be expected to happen again after Christmas.  Countries which had been very successful at containing the virus (South Korea, New Zealand) are also experiencing substantial increases.

All precautions previously mentioned and promoted by the CDC are still in effect.  The current guidance for Quarantine in Connecticut can be found here.

As to the two newly approved vaccines, I would make the following points:

  • Everyone knows that the vaccine has been rushed into production, but that makes sense given that the disease can be severe and that there is no effective conventional treatment.  Although the outlook for hospitalized patients is better now than it was in the spring, mortality for hospitalized patients remains high, especially for those on ventilators, and some people with milder symptoms and who do not require hospitalization are experiencing prolonged and debilitating problems.
  • This is a disease that is therefore worth preventing, if that can be done safely.
  • Although there have been a few reported severe reactions to the vaccine (see below), those appear rare, at least so far. More common is a “flu-like” state following the vaccine, which is mild-to-moderate (worse than with the influenza vaccine) but short-lived (1-2 days).  The vaccine should be given in a facility which can monitor the vaccine recipient for possible allergic reactions (which can be severe, even life-threatening) and  treat (with epinephrine, etc.) if necessary.
  • The long-term side-effects of the vaccine will take more time to be properly appreciated. Since most people will not have access to the vaccine for at least 3-4 months, by that time we will have more data.
  • The vaccine appears to be highly effecting (90% or greater), which is obviously a very good number. If widely used, this could reduce transmission to such a low level that fewer people would get sick and so that the economy could gradually reopen and family and community life could become more normal.  In the most currently optimistic assessment, this might happen as early as the summer of 2021.
  • 2 doses of the currently available vaccines, a few weeks apart, are currently being recommended to establish adequate immunity.
  • The high level of effectiveness of these vaccines is presumably related to their ability to promote activation of the body’s “innate” immune system, which is more basic than just promoting high antibody levels as other conventional vaccines do. I like this aspect.
  • What is not yet  known about these vaccines is whether they will prevent vaccinated persons from harboring and transmitting the virus. Therefore, until vaccination levels are widespread (late summer or fall most likely), or subsequent studies show this not to be a problem, vaccine recipients should continue to wear masks and practice social distancing.  The current  Connecticut regulations on Quarantine can be found here.
  • Regarding testing, DNA tests are still the “gold standard.” These can be done through nasal swabs  or through so-called “rapid” tests.  The rapid tests are just coming onto the market and may soon be available on pharmacy shelves for home use.  While these are not as accurate as the nasal swabs that use PCR amplification techniques, they are certainly better than nothing, and their substantially reduced costs may allow for repeated tests which will reduce the likelihood of a “false negative” result.The Nasal swab test that has been in use for several months now has been accused as being oversensitive because it can detect COVID-19 dna in amounts that are so small that the person may not be able to transmit the disease.  The likelihood of such a “operationally” false positive result depends on the extent of  “amplification” used by the laboratory.  More information on such “false positive” tests can be found here.

Seasonal Flu:  Currently there are extremely low levels of influenza-like-illnesses across the country.  There is a slight uptick in Oklahoma as of December 12th but activity is “minimal” in the rest of the country.  The most recent report from the CDC can be found here.

It is possible that the upcoming flu season will be very mild.  This may be due to reduced transmission from COVID-19 precautions (masks, social distancing, etc.) as well as the possibility that people will not seek care and testing for flu because of the COVID-19 pandemic.  More information regarding this can be found here.  Regardless, the flu virus will certainly circulate in North America this winter.

For those of you who use Influenzinum, there is no compelling reason to start taking it as yet.  But there is no harm in doing so either.  I am getting more calls as the season progresses.  I will continue to post as circumstances warrant.