COVID-19 Update #10

Monterey County (12/6/20 - 2/6/21):

24,541 new cases (40,532 total / 289 total deaths)

Worldwide (12/6/20 - 2/6/21):

39.7 million new cases (104.96 million total / 2.29 million total deaths)

U.S.A. (12/6/20 - 2/6/21):

12.39 million new cases (26.65 million total / 457,762 total deaths)

California (12/6/20 - 2/6/21):

2.01 million new cases (3.32 million total / 43,647 total deaths)


12/8/20

  • The UK starts vaccination of the Pfizer/BioNTech vaccine.

  • President Donald Trump signs an executive order for the USA to get priority for vaccinations derived from Operation Warp Speed (https://www.whitehouse.gov/).

12/9/20

  • Canada approves the Pfizer/BioNTech vaccine.

12/11/20

  • In early administration of the Pfizer/BioNTech vaccine, 2 recipients experienced a severe allergic reaction, but both of these individuals had a history of similar reactions to other vaccinations in their past and recovered with appropriate treatment.

  • In an analysis of 3,111,714 worldwide cases of COVID-19, even though both males and females have an equal risk of being infected by the SARS-CoV-2 virus, males tended to be nearly 3 times more likely to acquire severe disease (ICU admission) as well as death. Though not certain, some differences in the immune system may play a role, such as females having a higher number of CD4 T-cells, stronger CD8 T-cell activity, and a stronger antibody response from B-cells. Type-1 Interferon (IFN) is produced at higher levels by females, a powerful, inherent, antiviral protein. Oestradial, a prominent female sex hormone, is implied to promote T-cell responses, increase antibody production, and inhibit inflammatory cytokine production. Conversely, testosterone, the main male sex hormone, is associated with inhibiting the immune system (https://www.nature.com/articles/s41467-020-19741-6).

  • The US FDA issues an EUA for the Pfizer/BioNTech vaccine for ages >16 years, with a total of 2 doses, 21 days apart.

  • A double blinded, randomized, placebo controlled trial found the effectiveness of baricitinib and remdesivir combination therapy to be superior compared to remdesivir alone in the treatment of hospitalized COVID-19 patients with pneumonia. Those patients that needed high-flow oxygen recovered 8 days sooner with combination therapy compared to the placebo group and had fewer adverse events (https://www.nejm.org/doi/10.1056/NEJMoa2031994).

12/18/20

  • US FDA approves EUA for Moderna’s SARS-CoV-2 vaccine for adults ages 18 years or older after 2 total doses 28 days apart.

  • USA issues an EUA for 2 in-home SARS-CoV-2 tests. The first, created by Ellume, a non-prescription antigen test, can be used in those ages 2 years and older with or without symptoms and have results within 20 minutes. The second is the Abbott BinaxNOW COVID-19 At-Home Test, another antigen test with results available within 15 minutes. This requires a physician’s prescription and is to be used by those with symptoms only.

  • In a cohort study of 8.26 million adults, which included 4,053 Down Syndrome patients, it was found that this patient group had a 4-fold increase in COVID-19 hospitalizations and a 10-fold increased risk of death from COVID-19 (https://www.acpjournals.org/doi/10.7326/M20-4986).

12/21/20

  • USA passes the second COVID-19 economic stimulus bill of $900 billion.

12/22/20

  • New strain of the SARS-CoV-2 virus reported in the UK “VUI-202012/01” with 17 mutations (https://www.bmj.com/content/371/bmj.m4857).

  • “Long COVID” is a term that describes COVID-19 symptoms that last > 4 weeks status post acute infection and can include myocarditis/pericarditis (inflammation of the heart), microvascular angina, cardiac arrhythmias, mass cell activation syndrome, interstitial lung disease (inflammation of lung tissue), thromboembolic disease (blood clotting disorder), myelopathy/neuropathy/neurocognitive disorders, renal insufficiency (diminished kidney function), new onset diabetes mellitus, thyroiditis, hepatitis (inflammation of the liver), allergies/anaphylaxis, dysphonia, and heart failure (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32705-7/fulltext).

  • Long term symptoms in patients (“long haulers”) suffering from “Long COVID” greater than 14 days include the following: (https://www.cdc.gov/)

    • Fatigue

    • Cough

    • Congestion

    • Shortness of breath

    • Loss of taste/smell

    • Headaches

    • Body aches

    • Nausea

    • Diarrhea

    • Chest pain

    • Abdominal pain

    • Confusion

  • Risk factors of “Long COVID”:

    • Hypertension

    • Obesity

    • Mental health conditions

12/25/20

  • US President Donald Trump signs the “$900 billion COVID-19 Economic Stimulus Package”

12/30/20

  • UK and India issue emergency authorization (EA) for the AstraZeneca/Oxford vaccine

1/3/21

  • USA becomes the first country to report > 250,000 new cases of COVID-19 in a single day, at 284,554, a new single day record.

1/5/21

  • USA incidence:

    • 1 —> 5 million = 200 days

    • 5 —> 10 million = 92 days

    • 10 —> 15 million = 29 days

    • 15 —> 20 million = 24 days

  • USA deaths:

    • 1 —> 50,000 = 55 days

    • 50,000 —> 100,000 = 33 days

    • 100,000 —> 150,000 = 63 days

    • 150,000 —> 200,000 = 55 days

    • 200,000 —> 250,000 = 58 days

    • 250,000 —> 300,000 = 25 days

    • 300,000 —> 350,000 = 20 days

  • China grants its first official approval for its own Sinopharm SARS-CoV-2 vaccine.

  • The UK variant (B.1.1.7) mutation of the SARS-CoV-2 virus seems to allow the virus to infect cells more efficiently via mutations in the spike protein, and may be more easily transmitted, but studies thus far have not deemed the new variant to cause more severe disease or increased mortality. Initial studies have found no proof that the current vaccines will not be able to protect against the UK variant B.1.1.7.

1/6/21

  • 21 cases of anaphylaxis of 1,893,360 first doses (11.1/1,000,000). 17 of the 21 had a history of allergies/allergic reactions, while 7 had a history of anaphylaxis. Majority of the cases occurred within 30 minutes of the vaccination. As of this date, a new total of 29 cases of allergic reactions are reported in the USA and 0 deaths (https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm).

1/7/21

  • US records high for single day mortality of 3,844 deaths.

  • US record high single day incidence of 299,904.

  • Another SARS-CoV-2 variant emerges called B.1.351 (South African variant), which seems to be more readily transmissible.

  • Initial data suggests that the Pfizer vaccine is effective against both new SARS-CoV-2 mutations (UK and South African variants)(https://www.biorxiv.org/content/10.1101/2021.01.27.427998v1).

  • New study suggests that of the new variants, those individuals with the South African variant B.1.351, if given convalescent plasma serum antibodies as a treatment modality for acute disease, the neutralization could be decreased by greater than 10 fold, likely due to mutations at the E484 site on the Receptor Binding Domain (RBD) (https://www.biorxiv.org/content/10.1101/2020.12.31.425021v1).

1/8/21

  • Thus far, 4 countries have > 100,000 deaths:

    • USA = 365,000

    • Brazil = 200,000

    • India = 150,000

    • Mexico = 131,000

1/12/21

  • US CDC recommends patients who have had COVID-19 and recovered to still get vaccinated, as there is still uncertainty as to how long natural immunity will last and there is a risk of reinfection.

  • Recent study of 1,733 recovered COVID-19 patients showed that at the 6 month mark, 76% of patients reported at least one of the following symptoms: (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32656-8/fulltext)

    • There was a correlation with severity of initial disease (those requiring at least high flow nasal cannula oxygen) and prolonged symptoms.

      • Muscle weakness/fatigue (63%)

      • Pain/discomfort (27%)

      • Sleep disturbance (26%)

      • Anxiety/depression (23%)

      • Hair loss (22%)

      • Smelling disorder (11%)

      • Joint pain (9%)

1/13/21

  • For the first time ever, the USA reports > 4,000 COVID-19 related deaths on 2 consecutive days (1/12/21= 4,131 deaths and 1/13/21 = 4,096 deaths).

1/14/21

  • State of California posts guidance for in-person instruction for schools grades K-12 during the 2020-2021 school year (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Schools-FAQ.aspx). All grades can reopen if the county is in either red, orange, or yellow tiers.

    • Purple Tier:

      • Grades 7-12 not allowed to open.

      • Grades K-6 can reopen only if the COVID-19 infection rate is less than 25 cases/100,000 population for > 5 consecutive days.


1/15/21

  • As of 1/26/21 the USA will require any person traveling from another country by flight, have a negative SARS-CoV-2 test within 72 hours of departure or proof that they have had prior COVID-19.

1/19/21

  • USA surpasses 400,000 total COVID-19 deaths.

  • Worldwide mortality:

    • 1 —> 1 million = 262 days

    • 1 million —> 2 million = 109 days

1/20/21

  • A new variant of the SARS-CoV-2 virus (L452R) causes the first reinfection in Monterey County. This variant has been reported in multiple counties within California.

1/21/21

  • USA records a new record daily mortality (4,383).

  • Eli Lilly announces that bamlanivimab, a neutralizing antibody therapy, when used prophylactically, reduced the risk of acquiring COVID-19 by 80% after 8 weeks. Of note, this medication already had EUA as a treatment for COVID-19, not for prophylactic use.

1/22/21

  • Upon being president, Joe Biden reinstated the USA into the WHO, and mandated mask use by all federal employees and in federal buildings.

  • Initial studies suggest that the Pfizer/BioNTech SARS-CoV-2 vaccine will likely be able to protect against the B.1.1.7 mutation of the SARS-CoV-2 virus (https://www.biorxiv.org/content/10.1101/2021.01.18.426984v1)

  • Initial study reports that the South African variant of the SARS-CoV-2 virus (501Y.V2)/(B.1.351) may be capable of avoiding treatment by monoclonal antibody therapies as well as neutralizing antibodies in COVID-19 convalescent plasma. This is of concern as today’s available vaccinations look to promote the production of similar natural antibodies. This suggests that reinfection with this variant is possible (https://www.biorxiv.org/content/10.1101/2021.01.18.427166v1).

1/25/21

  • California regional Stay at Home Order ends.

  • According to Moderna, initial results show that the current vaccine is effective against the B.1.1.7 variant, but indicated a 6 fold reduction in propagating neutralizing antibodies against the B.1.351 variant and therefore is in process of developing a “booster” vaccine specifically for this new strain.

1/26/21

  • USA COVID-19 cases:

    • 1 —> 5 million = 200 days

    • 5 million —> 10 million = 92 days

    • 10 million —> 15 million = 29 days

    • 15 million —> 20 million = 24 days

    • 20 million —> 25 million = 23 days

  • US CDC reports 41.42 million vaccine doses available, but 22.73 million doses administered (54.9%). 19.25 million people have gotten first dose, 3.35 million have had both doses (average of 1.13 million doses per day).

  • New reports suggest that the B.1.1.7. variant may be more transmissible, as well as having a higher mortality rate.

1/28/21

Monterey County COVID-19 Vaccine Schedule.

Monterey County COVID-19 Vaccine Schedule.

1/29/21

  • US vaccinations/allergic reactions:

    • Pfizer vaccine: 50 cases of anaphylaxis (5 / 1 million doses)

    • Moderna vaccine: 21 cases of anaphylaxis (2.8 / 1 million doses)

    • No deaths reported from either vaccine

  • The first SARS-CoV-2 B.1.351 (South African) variant reported in the United States in South Carolina.

  • Johnson & Johnson/Janssen SARS-CoV-2 vaccine demonstrates 66% effectiveness in preventing moderate to severe COVID-19 in Phase 3 Trials.

  • NOVAVAX issues Phase 3 results for its SARS-CoV-2 vaccine, with an efficacy of 89.3% (2 doses, three weeks apart).

  • European Commission issues authorization for the AstraZeneca/Oxford University SARS-CoV-2 vaccine for those > 18 years old.

2/2/21

  • US government announced today that it will deliver 1 million doses per week of the COVID-19 vaccine to approximately 6,500 independent retail pharmacies (CVS, RiteAid, Walgreens).

2/5/21

  • US COVID-19 Mortality:

    • 1 —> 50,000 = 55 days

    • 50,000 —> 100,000 = 33 days

    • 100,000 —> 200,000 = 118 days

    • 200,000 —> 300,000 = 83 days

    • 300,000 —> 400,000 =36 days

    • 400,000 —> 450,000 = 16 days

  • 120 million vaccine doses have been administered worldwide in 65 countries:

    • USA = 35.2 million

    • China = 31.2 million

    • UK = 11 million

  • US CDC reports 57.49 million vaccine doses distributed and 35.2 million administered:

    • 27.19 million people = 1 dose (8.5% of total US population)

    • 6.93 million people = 2 doses (2.1% of total US population)


References:

  1. https://www.co.monterey.ca.us/government/departments-a-h/health/diseases/2019-novel-coronavirus-covid-19/2019-novel-coronavirus-2019-ncov-local-data-10219#sumaryreport

  2. https://www.co.monterey.ca.us/Home/Components/News/News/7609/1336

  3. https://www.centerforhealthsecurity.org/resources/COVID-19/COVID-19-SituationReports.html

  4. https://coronavirus.jhu.edu/map.html

  5. https://covid.cdc.gov/covid-data-tracker/#cases

  6. https://covid19.ca.gov/

  7. https://covid19.who.int/

  8. https://www.whitehouse.gov/

  9. https://www.nature.com/articles/s41467-020-19741-6

  10. https://www.nejm.org/doi/10.1056/NEJMoa2031994

  11. https://www.acpjournals.org/doi/10.7326/M20-4986

  12. https://www.bmj.com/content/371/bmj.m4857

  13. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32705-7/fulltext

  14. https://www.cdc.gov/

  15. https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm

  16. https://www.biorxiv.org/content/10.1101/2021.01.27.427998v1

  17. https://www.biorxiv.org/content/10.1101/2020.12.31.425021v1

  18. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32656-8/fulltext

  19. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Schools-FAQ.aspx

  20. https://www.biorxiv.org/content/10.1101/2021.01.18.426984v1

  21. https://www.biorxiv.org/content/10.1101/2021.01.18.427166v1

  22. https://www.co.monterey.ca.us/government/departments-a-h/health/diseases/2019-novel-coronavirus-covid-19/2019-novel-coronavirus-covid-19-vaccines

  23. https://covid19.ca.gov/safer-economy/

Image Source:

  1. https://www.co.monterey.ca.us/Home/ShowPublishedImage/33192/637472465341490073



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