As I’ve written before, every week our Medical Director, Marjorie Newman, MD, writes to our medical staff and gives them an update on all things COVID-19 related. The version she sends to staff is a bit more technical than this one, but the version below is an excellent summary of what is going on nationally, locally and micro-locally at Sansum Clinic.
She talks about a number of important themes:
Lots of information below. A little more technical this time, but well worth the read.
We do continue to hear the same questions from patients about vaccine availability and scheduling so at the end of Dr. Newman’s update, I have included a link to FAQs that many of you (we too!) have.
Dr. Newman and the rest of us are still smiling under our masks,
Kurt Ransohoff, MD, FACP
February 4, 2021
From: Marjorie Newman, MD
Re: Weekly COVID-19 Update
This past week the US continued to see a decline in the number of new COVID-19 cases, as well as a slight decline in deaths with 119,014 new cases reported on February 3rd and 3,843 new deaths which is a 30 % decrease in new cases and a slight decrease in deaths nationally over the past 14 days. The total number of COVID-19 deaths in the US since the pandemic began is a staggering 454,596. The good news continues to be that the number of new cases in California has continued to decline over the prior week, with 13,176 new cases reported on February 3rd, with 655 deaths, and 14,138 patients currently hospitalized (down from 18,000 just 10 days ago) reinforcing that we have passed the peak in cases and hospitalizations post-holiday season surge, with ICU capacity slowly improving. According to the CDC website, 35.2 million people have received at least one dose of a COVID-19 vaccine and 6.9 million people have been fully vaccinated with two doses (e.g., 1.9% of the US population has been fully vaccinated and 8.2 % have received at least one dose).
California Confirmed COVID-19 Cases:
As of February 3rd since the pandemic began there has been a total of 3.29 million positive COVID-19 cases reported in California and 42,466 deaths. The number of new cases reported on February 3rd is 13,176 and the number of new deaths reported is 655. The test positivity rate in CA is now at 10 % for the 7- day average.
The Johns Hopkins COVID Resource Website-depicts the dramatic decrease in the number of new cases in California (as of February 3rd).
There have been 3,984,752 total vaccine doses administered in California which is up from 1,393,224 doses last week (some of which are second doses so this number does not reflect the number of unique individuals who have completed the vaccine series). According to the CDPH website, 6.9% of Californians have received one dose of vaccine and 1.4% have received 2 doses.
The two graphs below from the California Department of Public Health website (as of February 2nd) depicts the trend in positive cases and total deaths due to COVID. Again, the good news is that the number of new positive cases per day is decreasing, now with under 15,000 new cases reported per day. Unfortunately the number of deaths per day has remained fairly steady with over 3800 deaths due to COVID-19 reported in CA in the past week. Ultimately with the decrease in the number of new COVID cases per day we will start to see a downward trend in the number of deaths over the coming weeks.
Impact on hospitals and ICU’s in CA:
On February 2nd the number of current hospitalizations due to confirmed and suspected COVID-19 cases in California reached a total of 14,138 which is a 3.1 % decrease from the prior day. The number of COVID-19 patients requiring ICU support is 3,756, which is a decrease of 16 from the prior day, along with a slight increase in the ICU bed availability from the prior week, with now 1,269 ICU beds reported as available in the state. Consequently, we are continuing to see a noticeable decrease in hospitalizations and ICU bed use with hospitalizations trending down and ICU bed availability slightly trending up as indicated in the graphs below.
Santa Barbara County
According to the Santa Barbra County Public Health Department website, as of February 3rd there are currently 1,231 active COVID-19 infections in the county with 167 people hospitalized and 47 in the ICU (35 patients are on ventilators and 10 ICU surge beds are in use). The number of people hospitalized is down 6% from the prior two week average. The cumulative death count is now 316 up from 275 last week. The test positivity rate in Santa Barbara County is now reported as 11.2 % which is slightly lower than last week. Cases are still occurring throughout the county. The hospital census at Cottage Hospital indicates a slow decline in the number of patients hospitalized due to COVID-19 and currently 51% of the patients on their census are COVID-19 positive. Critical care available capacity in the county is reported as 15%.
Santa Barbara remains in the Purple Tier indicating continued widespread transmission of COVID-19, with an adjusted case rate of 47.2 per 100,000 and a test positivity rate of 11.2%. In order to progress to the Red Tier the case rate target is less than or equal to 7 per 100,000 and the test positivity target of less than or equal to 8%.
COVID-19 Vaccinations in the County: As of February 3rd -67,700 vaccines have been allocated to Santa Barbara County, 51,375 doses have been distributed with 37,215 doses administered which is 72% administered.
The graph below reflects our Sansum Clinic weekly COVID-19 testing data for the week ending January 31st. As you can see, we continue to test fewer people through our Urgent Care and our Pediatrics Department as the county deployed a mobile testing van as a result of the surge in cases. The good news is that for the week ending January 31st our percent positive rate for Sansum Clinic has dropped again from 15.7% last week to 13.10% and from a high water mark of 26% a few weeks ago. Although trending in the right direction, there are still a significant number of patients testing positive through our testing program in the past week (~100 patients tested positive out of nearly 700 tested last week).
This second graph below represents the monthly trend of positive cases since the onset of the pandemic in March with the percentage of positive cases surging in January but hopefully with recent decrease in positive cases we are seeing, we will see the trend line decrease for February.
COVID-19 MONTHLY TREND SINCE THE ONSET OF THE PANDEMIC
(March 2020 to present)
Demographic Data for Sansum Clinic's Testing through 1/31/2021
The data shared above indicates that we are now seeing a decrease in COVID-19 cases. Despite that good news, there are still a significant number of cases in our community and now there is the added concern regarding the viral variants (e.g., UK, Brazilian, South African), which have now all been identified in the US. As a result, we need to continue to do all we can to try to limit the spread of disease with masking, physical distancing, washing hands and avoiding any gatherings with anyone outside of the immediate household, as well as do all we can to get everyone vaccinated as quickly as possible.
We continue to provide testing at the 215 Pesetas Lane COVID-19 testing trailer, Urgent Care and Hitchcock Pediatrics Departments as outlined in previous updates.
In an effort to enhance access to COVID-19 testing in the community the Public Health Department has deployed a mobile testing unit which will be available to support the expansion of testing throughout the county. The mobile unit has relocated from Santa Barbara and has moved up to Lompoc (Ryon Park), located at 800 West Ocean Avenue. Testing will still be available from 7:00am-7:00pm Monday through Friday. To request an appointment, individuals can go online to https://lhi.care/covidtesting or call (888) 634-1123 for an appointment.
COVID-19 Vaccination Efforts:
Some additional FAQs that have come up in the past few days:
Is there a new COVID-19 vaccine on the horizon?
Yes, Johnson &Johnson (J&J) has produced a viral vector vaccine and has just applied for emergency use authorization with the FDA. This vaccine is different from the mRNA vaccines that are currently being administered in the US. Viral vector vaccines use another non-replicating virus to deliver SARS-CoV-2 genes, in the form of DNA, into human cells where viral proteins are produced to induce protective immune responses. This viral DNA is not integrated into the host genome (i.e.., all of the body’s DNA) but is transcribed or copied into messenger RNA and translated into proteins. Current SARS-CoV-2 viral vectored vaccines use non-replicating human or chimpanzee adenoviruses, including those by AstraZeneca with the University of Oxford and Johnson & Johnson’s vaccine.
Adenoviruses are a group of approximately 50 common viruses that can cause cold-like symptoms, fever, sore throat, diarrhea, and pink eye. The human adenovirus vectors used for SARS-CoV-2 are weakened forms of adenovirus 5 and adenovirus 26. The weakened vectors do not replicate because important genes have been deleted. Viral vectors have been studied for several decades for gene therapy, to treat cancer, and for research into molecular biology as well as for vaccines. Large-scale production of viral vector vaccines requires cultivation of the viral vector, such as adenovirus, in cell cultures and virus purification.
Most people have been exposed to multiple adenoviruses and may have pre-existing immunity that could impair vector entry into host cells. This is a potential limitation of viral vector vaccines using human adenoviruses. The AstraZeneca and University of Oxford vaccine uses a chimpanzee adenovirus as vector, thus minimizing the risk of pre-existing immunity to the vector that might reduce vaccine efficacy.
The Johnson &Johnson vaccine is a single shot vaccine, which is a great benefit over the current mRNA vaccines, which require two doses, and it doesn’t require ultra-cold storage as the Pfizer vaccine does. The J&J vaccine can be stored at refrigerator temperatures for up to three months. It was shown to be 72% effective in the US and 66% effective overall at preventing moderate to severe COVID-19, 28 days after vaccination in a global study of nearly 44,000 people. The vaccine did better at preventing disease in the US and less well in South Africa, which is a bit concerning as a result of the variant that has been recently detected in the US. The vaccine did demonstrate complete protection against COVID-19 serious enough to require hospitalization-the vaccine was reportedly 85% effective in preventing sever forms of the disease. We will keep you updated about the J&J vaccine as we learn more.
What are coronavirus variants?
All viruses mutate in an effort to enhance their ability to survive and spread and the SARS-CoV-2 virus, which causes COVID-19, is no different. It was expected that the virus would mutate as it continued to infect its host (humans) and spread in communities. However, the concern is that some of these new variants have been found to be more infectious and potentially more virulent and others appear to be less susceptible to certain treatments like monoclonal antibodies and vaccines. As a result, the CDC is closely monitoring three primary variants of concern which are denoted as the UK variant, South American Variant (Brazil), and the South African variant, based upon where they were first identified.
In December 2020, British officials announced that scientists had discovered a new, potentially far-more-contagious variant of the novel coronavirus—labeled B 1.1.7—in the United Kingdom (termed the UK variant). U.K. officials said the variant had mutations that affect how the virus attaches to and infects cells in the body. For example, one mutation called N501Y improves how the spike protein of the virus—which is the part of the virus that infects human cells—attaches to the ACE2 receptor on human cells, meaning the virus is more likely to infect cells successfully. Public health experts are concerned about B 1.1.7 because recent research suggests it is about 56% more contagious than the un-mutated coronavirus, and researchers have now detected the variant in at least 55 countries, including 32 states in the United States, with nearly 500 cases now reported. The majority of cases in the US have been reported in Florida and California with 90 detected cases detected in San Diego. The CDC has warned that the new variant could become the dominant coronavirus variant circulating within the United States by March. According to public health experts, a more-contagious variant means new cases of the coronavirus could accelerate, and as a result hospitalizations and deaths tied to the virus could spike as well. Also, last week preliminary research suggested that there may be a higher level of severity of illness with this variant, but the good news is that the two authorized coronavirus vaccines (Pfizer and Moderna) are effective against B.1.1.7, meaning vaccinations—along with adherence to public health measures intended to curb the coronavirus's spread (masking, social distancing)—could help tamper B.1.1.7's effects.
South African and Brazilian Variants:
Scientists had discovered another new coronavirus variant in South Africa, called B.1.351, that similarly features the N501Y mutation (as indicated above). But B.1.351 also contains an additional mutation called E484K, which occurs on a part of the spike protein that's instrumental in attaching the coronavirus to ACE2 receptors in human cells. Scientists have also identified the E484K in a coronavirus variant circulating in Brazil (also known as the P1 variant). Researchers have feared that coronavirus variants with the E484K mutation might be less vulnerable to current Covid-19 vaccines. Recent studies have indicated that viruses with the E484K mutation are not recognized as well by antibodies, meaning coronavirus variants with the E484K mutation—such as B.1.351—could potentially bypass immune protection. Of note, these studies were published online and haven't yet been peer-reviewed. Their findings are based on laboratory experiments conducted using blood samples from certain patient groups, so the results don't necessarily reflect observations of what's occurring in the real world. However, the results are nevertheless concerning, according to the CDC and CDPH. Apparently, the studies indicate that the B.1.351 variant is less susceptible both to the antibodies people produce from being infected by the novel coronavirus and by receiving Covid-19 vaccines manufactured by either Pfizer/BioNTech or Moderna, (the two vaccines currently authorized for use in the United States). During a recent scientific conference held online, scientists in South Africa who conducted one of the studies said that, in lab tests, serum samples from 21 of 44 patients who'd had Covid-19 failed to destroy engineered viruses with the B.1.351 variant's spike protein. However, the scientists also noted that serum samples from three Covid-19 patients who'd been hospitalized from the disease did destroy the variant. The scientists said those patients had higher levels of neutralizing coronavirus antibodies in their blood than the patients who had mild cases of Covid-19. In a second study performed at Rockefeller University in New York—researchers tested serum samples from 14 patients who'd received Moderna's vaccine and six patients who'd received Pfizer/BioNTech's vaccine against engineered viruses that contained three of the key mutations found in the B.1.351 variant. The researchers identified a small decline in antibody activity against the viruses—which was felt to be a significant result because it was seen in all individuals tested. Overall, the researchers said the findings mean that Covid-19 vaccines may need to be updated periodically to avoid potential loss of clinical efficacy. Currently, the South African variant has been detected in two states (South Carolina and Maryland), in three individuals and none of the individuals have any history of travel or any connection to each other, indicating that the variants may have been spreading silently and are likely elsewhere in the US but just haven’t been sequenced yet. The Brazilian variant had been detected in Minnesota last week in a person who had recently traveled to Brazil.
Variant of Interest in California:
Lastly, there is another variant of interest that was detected in California, in July, denoted as variant L452R. This variant accounts for approximately 25% of recently sequenced specimens in California and there are potential concerns about this variant being more infectious and potentially less susceptible to vaccine. Studies are ongoing about this variant and we will share more data once available.
Will vaccines need to be updated as a result of these variants?
Likely yes-vaccine manufacturers might have to update their inoculations to address new variants of the novel coronavirus, and that people might have to get vaccinated against Covid-19 regularly, similar to flu vaccines. Last month, Pfizer/BioNTech indicated that they would be able to adjust their vaccine in a timeframe of about six weeks. As a result, of the mRNA technology used to make these vaccines they note that they can directly start to engineer a vaccine that completely mimics this new mutation and theoretically it could be manufactured within six weeks. Moderna indicated that it was developing a "booster shot" for its vaccine after a pre-print study suggested that it seems less protective against the variant identified in South Africa. Specifically, the company found that while the British variant had no effect on the levels of neutralizing antibodies produced once someone was vaccinated, the South African variant was correlated with a six-fold reduction in those levels. However, Moderna noted, even those reduced levels remain above levels that are expected to be protective. According to Moderna, the booster shot would be given roughly one year after someone received the original vaccine. Officials added that they expect to develop the booster shot in slightly less than 42 days, which was how long it took for the company to develop its original vaccine.
Should I wait to get an “updated” version of the COVID-19 vaccine which combats these variant strains?
No, you should not wait. Public health experts indicate that since these variants are already circulating in the US it is more important than ever for everyone to follow public health guidance of wearing masks, washing hands, and staying away from people who don’t live with you (especially in doors) and getting vaccinated as soon as it is offered and available. Preventing the virus from replicating and spreading (e.g., public health measures and vaccination), is the best way to prevent the virus from mutating. That is why it is so important to continue to do all we can to continue to mask, wash hands, not gather with anyone outside of the household and get vaccinated when it is offered. Despite the potential concerns about the variant strains, scientists say that the current Covid-19 vaccines still are highly likely to prevent severe cases of Covid-19, so people should definitely continue getting vaccinated. In fact, researchers have stated that if the goal is to keep people out of the hospital, then the current vaccines will be very effective. However, current vaccines might not stop people from developing mild cases of Covid-19 or contracting an asymptomatic coronavirus infection. And if those individuals can transmit the virus to others, it could harm those who haven't yet been vaccinated or previously infected. That's why public health experts are urging people to continue practicing other measures—including physical distancing, frequent hand washing, and mask wearing—to prevent the coronavirus's spread.
Is Double Masking recommended?
Recently there has been a lot in the lay press regarding double masking as a way to have greater protection against the more transmissible COVID-19 variants. The CDC has not issued official guidance on double masking, but other experts, including Dr. Fauci, have indicated that wearing two masks (having more layers) is likely better than one to prevent the spread of viral particles both protecting the wearer from others who may be shedding virus and protecting others from the wearer, especially in situations where there may be a lot of people around (e.g., grocery store, etc). However, other experts are less concerned about double masking to protect against variants and more concerned about people who aren’t masking at all. In fact, if double masking makes it more uncomfortable or less likely that someone will wear a mask at all when they should, that will defeat the purpose. Bottom line is that masking is critical when leaving the house and more layers and a secure seal around the nose and mouth is going to be more effective than fewer layers or a loose fitting mask. More information will likely be forthcoming on mask quality and recommendations for the public and we will provide updates as we learn more.
Do I still need to wear a mask and avoid close contact with others if I have received 2 doses of the vaccine?
YES!. While experts learn more about the protection that COVID-19 vaccines provide under real-life conditions, it will be important for everyone to continue using all the tools available to us to help stop this pandemic, like covering your mouth and nose with a mask, washing hands often, and staying at least 6 feet away from others. Together, COVID-19 vaccination and following the Public Health Department’s guidance for how to protect yourself and others will offer the best protection from getting and spreading COVID-19, especially with the new concerns about variant strains. Experts need to understand more about the protection that COVID-19 vaccines provide (e.g., duration of protection, ability to prevent shedding of virus, etc) before changing recommendations on steps everyone should take to slow the spread of the virus. Other factors, including how many people get vaccinated, how the virus is spreading in communities, predominant variants in the community, will also affect public health guidance which may vary based upon the region depending on the factors outlined above. Again, more data and more time will help inform these decisions but we do know that getting vaccinated is a critical step in the process of getting “back to normal”.
We hope the above information has been helpful. Please continue to follow all of the public health guidance regarding masking, hand washing and social distancing. Please get vaccinated when it is offered and, as always, don’t hesitate to reach out for any questions.
Marjorie Newman MD
Frequently Asked Questions
Sansum Clinic continues to hear the same questions from patients about vaccine availability and scheduling. Please click here to find a comprehensive list of frequently asked questions and answers.