COVID-19 Pandemic Update
-At this time, international travel needs to be carefully considered if you are unvaccinated.
-Please check for updated information regarding entrance requirements (testing and COVID vaccination) through your destination country’s official website. Go to the US. Department of State for country-specific travel advisories related to COVID. For more general COVID and COVID-testing information, visit the CDC site: International Traveler’s COVID-19 Testing Requirements.
-Unpredictable border-closings, potentially inaccurate data about COVID-19 case numbers from many countries, and severe limitations of medical resources outside the US if you should become ill are some of the current issues involved with international travel.
(Dr. Klapowitz will review COVID information with you further on your travel medicine consultation visit.)
-Multiple countries are working on dozens of vaccinations. Moderna, Pfizer/Biontech, and Johnson & Johnson have all received EUA (Emergency Use Authorization). So far, all 3 vaccines appear safe and effective.
-Life-threatening allergic reactions, called anaphylaxis, are rare (about 5 in a million vaccines administered), but still several times more frequent than the flu vaccine. A history of anaphylaxis to vaccines, bee stings, or other medications/substances increases the likelihood of anaphylaxis to the COVID-19 vaccine.
-The Pfizer vaccine may be rarely associated with a few day episode of myocarditis and pericarditis (heart muscle inflammation) in teenagers and adolescents that appears to resolve spontaneously.
-Moderna and Pfizer shots appear to be very effective at preventing the disease and nearly 100% effective at preventing hospitalization and death from COVID-19.
-While the Johnson and Johnson vaccine appears to be as protective as the other vaccines against severe and lethal disease, it may be slightly less effective for mild to moderate disease. Also, the AstraZeneca vaccine (not available in the U.S.), that is similar to the J & J vaccine, appears less effective than Moderna or Pfizer against the U.K. and India variants and is ineffective against the S. African variant.
-One episode of abnormal blood clotting per million doses of the Johnson and Johnson vaccine has occurred.
-All three vaccines are believed to significant lower transmission rates. This means that it is unlikely a vaccinated person will transmit COVID-19 to an unvaccinated person. (Data is still pending)
-It appears that other vaccinations may be given without regard to timing of the COVID vaccination (the guideline of 2 weeks was modified late in May). However, this may make it difficult to determine which vaccination is causing side effects, if side effects occur (COVID vaccine is frequently associated with significant, though usually short-term side effects).
GENERAL COVID-19 INFORMATION
NAME OF VIRUS AND ILLNESS: The World Health Organization has named the new coronavirus SARS-CoV-2 (“severe acute respiratory syndrome coronavirus 2”). The disease SARS-CoV-2 causes is called “coronavirus disease 2019” (COVID-19).
SYMPTOMS: SARS-CoV-2 causes fever and cough in nearly all cases of symptomatic COVID-19, and shortness of breath if severe. Decreased sense of smell, and a corresponding decrease sense of taste, has been reported to be associated with COVID-19 as well in a significant percentage of patients. Other symptoms such as diarrhea, sore throat, headache, are less common, but can be see in COVID-19. Chest x-ray usually shows pneumonia in both lungs (“bilateral pneumonia”). PLEASE NOTE: “Pneumonia” refers to lung tissue inflammation caused by bacteria, viruses, and other medical issues. Vaccines that we have in the US to protect against pneumococcal pneumonia (Pneumovax, Prevnar 13), a bacterial infection, DO NOT provide protection against COVID-19. In fact, there is no evidence that any vaccine we currently possess (“flu,” measles, etc.) provides any protection whatsoever against coronavirus. These vaccines provide important protection against other diseases, some of which can even develop alongside COVID-19.
TESTING FOR ACTIVE DISEASE: Currently, the most accurate tests for identifying if someone is actively infected with coronavirus are the nasal and oral swab PCR (polymerase chain reaction) tests and other Nucleic Acid Amplification Tests (NAAT) tests.
TESTING FOR ANTIBODIES: All antibody tests should be performed at least 3-4 weeks after COVID-19 symptoms or exposure…less time elapsed than that results in a much higher false negative rate. A positive antibody test may mean you have short-term immunity, but we do not know this for certain.
IMMUNITY? Prior infection with COVID-19 is not felt to be as protective against reinfection as vaccination. Also, infection with an early strain of COVID-19 may not protect against a newer strain. So far, the vaccines we use in the US appear to protect against all old and new strains.
IF YOU TEST NEGATIVE FOR ACTIVE DISEASE: Please discuss this with your doctor. It is possible that the result is a “false negative” (you are positive but your test says “negative.”
PREVENTION: “Social distancing” (staying 6 feet from others) is effective at decreasing transmission of the virus, as is restricting gatherings and closing places where groups of people congregate (schools, restaurants, etc.). Wearing a mask decreases the rate of coronavirus transmission. Wearing masks when you have no symptoms also appears to decrease transmission in the community and has been definitively proven to decrease transmission in clinical settings. (See CDC’s Cloth Face Mask Recommendation.) Face shields may provide some protection if you cannot wear a mask for medical reasons, but they are not considered an adequate face-mask substitute by the CDC.
CONTAGION: People can transmit COVID whether or not they have symptoms. COVID-19 is significantly more contagious than the “flu.” This is supported both by worldwide data case data and by our clinical experience locally.
- People who finished their vaccination series 2 weeks ago or longer do not need to isolate if they are exposed to someone with COVID-19.
- The average length of time between exposure to coronavirus and development of symptoms is 5 days.
- People who may have been exposed to the coronavirus are asked to isolate themselves for two weeks to make certain they do not develop symptoms of COVID-19 and do not put others at risk. If they then develop symptoms during isolation, see: “people with COVID-19 symptoms.”
- People with COVID-19 symptoms (with or without a positive test) go into isolation for ten days after the start of symptoms. At the end of isolation, an individual must also have been without fever (without Tylenol, Motrin, Advil, etc.) and with decreased symptoms (cough, etc.) for one day in order to safely end isolation. The CDC recommends a person should not return to work for 10 days after symptoms start and there are no symptoms for three days in a row. For the NYS DOH guidelines on quarantine and isolation, see: Quarantine Guidelines.
- People with no symptoms but who have a positive test (nasal or oral swab) must stay in isolation for 10 days.
- Specific exceptions to the above rules exist for hospitalized patients, severely immunocompromised patients, patients discharged from hospitals to nursing homes, and healthcare workers.
RISK FACTORS strongly associated with increased hospitalization and death due to COVID-19: Older age, significant heart disease, cancer, chronic kidney disease, emphysema, severe obesity, sickle cell anemia, receiving a solid organ transplant, type 2 diabetes, and active smoking. There is mixed or limited evidence that other medical issues (high blood pressure, asthma, and others) affect outcome of COVID-19 adversely.
TREATMENT: Remdesivir (Veklury) was approved (EUA) October 22nd for COVID-19 for patients requiring hospitalization. There is weak and conflicting evidence that it is effective. Bamlanivimab was approved (EUA) November 9th for patients who are not hospitalized but at risk of severe COVID-19 complications. A combination of Remdesivir and Baricitinib received EUA November 19th for severely ill, hospitalized patients.On November 21st, 2020, Regeneron’s combination of Casirimab and Imdevimab received approval for mild to moderate COVID-19 patients at risk for hospitalization and severe disease. None of the these drugs or monoclonal antibodies is yet associated with overwhelming evidence that they are effective at preventing disease progression or reversing severe disease at this time. The effectiveness of infusions of antibody-containing plasma from recovered COVID-19 patients is still under debate. A commonly used steroid, hydrocortisone, may improve outcomes for oxygen-requiring and intubated COVID-19 patients.
REINFECTION? We do not know how long immunity to COVID-19 lasts after infection. The reinfection rate within the first few months is likely very low.
RETURNING TO “BUSINESS AS USUAL: Hopefully, as the numbers of people vaccinated to COVID-19 increases, case numbers will continue to decrease.
…To Be Continued
For more information regarding coronavirus, go to CDC Coronavirus Information.