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News of Otsego County

Life in the time of COVID

STERNBERG: COVID Transforming Calls For Better Understanding
LETTER from RICHARD STERNBERG

COVID Transforming Calls

For Better Understanding

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Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional perspective weekly during the COVID-19
threat. A village trustee,
he resides in Cooperstown.

There is a large amount of concern about this new strain of COVID that just Monday was confirmed to have reached New York State.

At this time, I keep hearing that it is more contagious than the strain we are familiar with but not more lethal.

What we don’t know, and what we will have to find out, is whether it is as sensitive to the approved vaccines as the strain we are most familiar with.

I am personally concerned that we are losing our focus on standard epidemiologic ways of preventing spread: This is not the time to give up on distancing, masks, and avoiding groups let alone crowds.

In preparing these columns, as I have stated in the past, there is a plethora of new information available every day.

There are at least 50 articles I can choose from, not including original scientific journal articles, that number several hundred each week on all platforms. None of these individual articles can give an overall picture of what is happening and the basic science in an organized fashion.

Interestingly, a close friend, an electrical engineer, turned me onto an online course offered by the Massachusetts Institute of Technology this past semester for undergraduates and graduate students. There were 13 lectures, about 45 minutes long, on many aspects of the COVID-19 crisis by experts who are leaders in their fields. The course is available to anyone online at no charge.

While some of the lectures, and lecturers, are a bit esoteric, some were quite easy to follow. Many explain things so simply and well that the average interested person can come away with a fairly complete understanding of the important points of this pandemic and how the biology behind treating it works and is implemented.

I suggest at least taking a look at it and going over some of the lecturers. I admit several of the lecturers, while leaders in their fields, had problems speaking to a non-technical audience but most of them did a good job of educating overall.

To access the course, Google “MIT course 7.00”, then hit the first listing. Individual lectures can also be found through YouTube.

I am over 40 years from studying this material as coursework and much of what we know about viruses and immunology has changed since then but as I said above, some of the lecturers were able to distill out the essence of what they were saying so that anyone with only a high school biology background could follow it.

I particularly found interesting the first lecture, “COVID-19 and the Pandemic,” the second lecture “Corona Virus Pathology” and the fourth lecture, “Insights from the Corona Virus Pandemic” (which is given by Dr. Anthony Fauci, who is a wonderful teacher)

Number 10, “Vaccines”, is also among the easiest to understand for non-technical audiences.

It is very important that all of us try to obtain as much factual knowledge as possible.

Only in this way can we make informed decisions for ourselves and our families. Taking a course like this one I describe is as equally important as to gathering information by reading individual articles.

STERNBERG: Vaccines, Part II: They Arrive
LETTER from RICHARD STERNBERG

Vaccines, Part II: They Arrive

Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional perspective weekly during the COVID-19
threat. A village trustee,
he resides in Cooperstown.

I wish I had the time, stamina, and column inches to write an article daily. That’s how fast the news is coming.

Since last week, Pfizer has begun distribution and vaccinations around the nation, the Moderna vaccine has been approved and it will start distribution by the time you read this, with inoculations going into arms probably by Thursday the 24th.

The 350 Tier One healthcare workers from Bassett Healthcare will have been inoculated, though they all had to travel to either Utica or Elmira to receive the network’s allotted doses, according to a Bassett spokesman. They will get the Pfizer vaccine.

According to the Governor, we can expect more doses in the weeks ahead.

All I want for Christmas is my two vaccines.

There have been some surprises with the roll out. It seems some five dose vials of the Pfizer vaccine actually contain six doses. On the other hand, the logistics have not gone quite as well as we were told to expect. I guess that’s not a surprise.

In the United States, the priority for the order of who gets the vaccine has been announced.

Tier One-A is front-line healthcare workers and nursing home residents and staff.

Tier One-B is essential workers.

Tier One-C is high risk individuals which includes those over 60 or 65 depending on their state of residence and those with other risk factors.

After that I am not sure but it seems to be everyone else lumped together. It is not clear when and if minors will get the vaccinations, since they haven’t been tested in those under 16.

There has been some controversy over the 1-B group, not so much if essential workers should get it next, but who is an essential worker.

Overall, there are probably more than 20-30 million people in this category in the United States: police, fire, EMS, teachers, other healthcare workers who interact with the general public, grocery store workers, food processing plant workers, certain other government employees, and many others.

As someone with eight risk factors and counting, I am willing to wait my turn for most of these, but unfortunately there will be some who get moved up the list but probably don’t deserve it.

For example, an attorney friend of mine in New Jersey says they are classified as essential workers.

Shakespeare would definitely not agree. Neither do I. Some yes, but all of them? Corporate attorneys who haven’t been in a courtroom in decades and only represent clients who can pay them more than $500/hour?

There are other vaccines coming out soon. Janssen/ Johnson & Johnson, AstroZenica/Oxford, and Novavax are among those in stage three testing in the USA that may be able to get FDA approval.

China and Russia have both approved their own vaccines and are inoculating people at home and overseas.

The entire United Arab Emirates’ Tour de France winning cycling team has been inoculated with the Chinese Sinopharma vaccine.

Hopefully the vaccines from outside North America and Europe will also generate honest, reproducible data. We need every dose that can be produced that works. There are seven billion people in the world and frankly most of them would benefit by being vaccinated.

In the meantime, we can decrease deaths and slow down progression of the disease with the same simple methods that I have been advocating for nine months. (Yes, it’s that long.) Wear a mask, socially distance, don’t get lackadaisical just because you know some else well.

My god-daughter and her husband both contracted it from their 11-month-old. All are well. We just lost an Otsego citizen who caught COVID from a group home worker who contracted it at a Thanksgiving dinner.

Small group, known people. But someone died because of it. We are so close, people: Stay the course (and any other cliché you can think of).

Merry Christmas and I wish everyone a New Year that at least begins to approach sanity.

STERNBERG: Getting Closer To Vaccine. Then What?
LIFE IN THE TIME OF COVID-19

We’re Getting Closer To A

COVID-19 Vaccine. Then What?

Sternberg
Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.

It appears that we are getting closer to the development of vaccines for COVID-19.

There have been some missteps in the process, including the development of an unexplained illness in one participant in the U.K. study of the AstraZeneca/Oxford vaccine. This required a halt to the study for about a week while the data was being reviewed. The study is progressing again at this time.

There are multiple other studies. Some of the vaccines are further along than others.

It’s not going be enough to develop one vaccine. The number of doses that can be produced quickly is limited. It is currently estimated the first batch will be limited to perhaps 10 million to 15 million doses in the United States, according to the National Academy of Medicine. This is why it’s important to have multiple vaccines available so they can be produced in tandem.

So, the question comes back to triage, which is something we first discussed six months ago. In this case, in what order are the vaccines going to be rolled out? Who is going to get them first? Where are they going to be distributed first? Right now, this is a matter of heated opinion.

• In my opinion, and solely in my opinion, I feel the following distribution order should be performed:

• One, frontline healthcare workers who are dealing with patients with COVID-19, or can reasonably expect to come into contact with patients and other affected people with COVID-19. This would include people working in hospitals, nursing homes, emergency medical services, and clinics.

• Two, other essential workers at high risk of being exposed to patients, or people who have
COVID-19 or are positive for the SARS-CoV-2 virus.

• Three, those with two or more risk factors, including age.

• Four, health care and essential workers at any risk of exposure based on their job.

• Five, those with only one risk factor.

• Six, children.

• Seven, adults older than 25.

• Eight, young adults.

My only exception to the above is that I would withhold vaccination for all those who have refused to social distance, wear a mask, have publicly proclaimed that the pandemic is a hoax, or have attended illegal mass gatherings.

At the rate that we can expect vaccinations to roll out, at best we will probably only get the first and possibly some of the second group inoculated within the next three to six months.

With the development of more vaccines by different companies, we might be able to get the entire United States vaccinated within nine to 15 months.

This of course does not discuss the problem of whether money or fame puts you at the head of
the line.

As many of us have noted, professional athletes have been getting tested at will so they can go back to their sports. Other people have to wait or had to use tests that are not instantly available.

We can predict a similar occurrence with who gets the vaccine first. Should VIPs have priority? Should their families? Should the vaccine be equally available in countries which develop it versus non-developed countries?

Just as it was a mad scramble for supplies when lockdowns first began, there’s going to be a mad scramble for the vaccines with people trying to find reasons to be put at the head of the line.

Ultimately there’s going to have to be some pre-existing protocol, or decision-making process in place to sort this out.

As I said above please contact me with your thoughts on these issues. I will make your responses the subject of a follow-up column.

STERNBERG: Studies Seek Vaccine, Treatments

LIFE IN THE TIME OF COVID

Studies Seek Vaccine,

But Treatments Too

Sternberg
Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.

There has been a great deal of information both published and awaiting publication in the scientific literature about COVID-19. There’s so much literature it’s sometimes difficult to separate the wheat from the chaff, determining how accurate information may be no matter how well-meaning the researchers.

In the treatment of COVID-19. There are no fully FDA-approved medications or treatment protocols. So far, the FDA has released EUAs (emergency use authorizations) for certain medications or use of products.

An EUA is not formal approval in the legal sense of the word but rather, in times of declared states of emergency, allows use of an unapproved product or an approved product in an unapproved manner.

This is still based on scientific evidence and requires a review process, but it is not as stringent
and time consuming as a full FDA approval, which usually takes years.

Obviously, in the situation we are in now, we don’t have years.

An article published last week online by the Journal of the American Medical Association reviewed multiple studies on the effectiveness of using corticosteroids to treat COVID-19.

This showed that, in a statistical review of the pooled results of seven studies, systemic (intravenous) use of corticosteroids decreases the mortality rate of patients with severe COVID-19 by 20 percent.

The interim review of these studies so strongly showed a benefit of the use of steroids that further studies were halted since ethics required now treating all patients with severe COVID-19 with steroids.

Last week, the FDA extended its EUA for remdesivir, an antiviral drug. Previously, this drug had been allowed only for severe cases of COVID-19 with respiratory distress, but on Friday a statement was issued stating that, on the basis of all the literature available, the FDA felt it was reasonable to believe that Veklury (remdesivir) may be effective in the treatment of suspected or laboratory-confirmed COVID-19 in all hospitalized adult and pediatric patients and that the potential benefits outweigh the known and potential risks of its use.

The report did go on to say that more study was necessary to determine and confirm these results and to determine which patients stood to benefit most and at what dosage and over how long a course. The study was performed by the NIH.

In the early days of the pandemic, when there was spiking of cases in the U.S. and especially the Northeast, physicians used ventilators based on what they knew from other disease processes.

Based on what has been tried and learned from treating COVID-19, protocols have been
changed dramatically. Even determining which patients will benefit from a ventilator has been reconsidered.

Finally, one thing that I found particularly exciting was the use of Artificial Intelligence in helping to find treatments. AI is being used to predict what drug combinations in specific combinations and doses might be effective.

AI can cross-reference all known information about how a drug works and dosage schedules with those of other drugs and recommend treatment applications.

For example, while remdesivir has been proven to be statistically effective and, so far, is the most effective anti-viral treatment known, it still is not anywhere near universally effective.

An HIV medication, lopinavir/ritonavir, which had been tested and found lacking against COVID-19 when used by itself, has been suggested as making remdesivir more effective when combined. Based on the prediction, a study is in progress.

Scientists are not just waiting for an effective vaccine to try to prevent COVID-19 infection but continue to actively work on treatments for people who already have the disease. As time goes by, more information will be found and will be better vetted so that treatment options improve.

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