It appears the summer surge of COVID-19 in the United States is abating.
Numbers are going down except in the hardest hit states. The average number of deaths last week was approximately 1,800 per day and the number of daily infections is about 100,000. These seem to be trending down but if they flare up again and represent averages over the long-term we are talking about 675,000 deaths per year. By comparison, in the United States, the flu kills somewhere between 10,000 and 50,000 people a year. If the flu pandemic of 1918 is any guideline, we should expect further surges with the number and severity of the surges dying out eventually.
Last week, Merck and Company announced that an experimental pill they are working on to treat COVID-19 early in the course of the disease to keep patients from becoming seriously ill or dying is proving safe and effective. After discussion with the FDA, it and Merck felt the results were so good they decided to close additional enrollment to the trial. They will finish out the study in approximately November and then present the results and ask for approval for emergency authorization. Production of the pills has already started so as to be ready for rapid distribution when approved.
This is the first easy-to-use treatment specifically for COVID. It is a pill that when taken as prescribed early in the course of symptoms will decrease the risk of hospitalization and death by about 50%.
The drug is called malnupiravir. It is in oral form and easily taken at home. It must be started within five days of the onset of symptoms. This makes it important for people who have symptoms consistent with COVID-19 to get tested immediately (there is now a national backlog of testing, slowing down availability of results) and see their doctor at the onset. Treatment is eight pills daily for five days. This is very much like oral medication people use at early onset of influenza.
Several months ago, I stopped writing my weekly column on life in the time of Covid-19. The rollout of the vaccinations was going well locally, the numbers of people hospitalized locally were low, and organizations were opening up. The Rotary Club that I belong to in Cooperstown was making plans to go back to meetings in person.
I was also recovering from major surgery and it was difficult physically to put together the columns.
I thought for the most part my job was done. Now, here we go again.
In many places in the United States the numbers of the sick and dying from Covid-19 are rapidly increasing in areas where there is a low percentage of vaccinated individuals. It also correlates with places that opened in an unrestricted fashion. Many first-line healthcare workers are completely burned out and can’t begin to understand how people who could have avoided this very deadly and debilitating disease refused to do so and even refused to acknowledge that in many cases it was real. What is particularly disturbing is seeing patients begging to be vaccinated as they are being rolled into intensive care units.
Yes, there is a risk of complications from vaccination. There is a risk of complications from everything we do or food we eat or medicine we take. Riding in a car is a risk.
• The village has received $89,000 from the federal government as part of the corona-virus relief package. Tillapaugh said it is much less than she anticipated or the village lost in 2020 because of the coronavirus pandemic and shutdown. The assignments were based on population, a formula that did not favor Cooperstown, she said. The village will receive a similar amount in 2022 as part of the package.
• The trustees unanimously approved a special-use permit for a multi-unit dwelling at 20 Glen Ave. No one spoke about the matter in the public hearing.
On a recent morning, I had a first visit/consultation with a physician from Columbia-Presbyterian in New York City. In going to the city and back to Cooperstown, Columbia presents a special challenge to me.
It is a difficult facility to maneuver through under fully normal conditions and these times aren’t normal. It would have required driving about four hours each way and maybe even an overnight stay. Both the physician and I chose to do a telemedicine visit.
Most of you already know about telemedicine.
It was starting to be used by patients who had to travel long distances to see a doctor, especially if there was a satellite clinic where the transmission could be accommodated. Now, with the advent of multiple video options, the patient can be anywhere, from home to half the world away.
At the beginning of the COVID-19 lockdowns, many large practices, including hospital-based ones, decided video and telephone appointments were better than nothing. What they found out was that many times they were equal, if not better, than an in-person visit.
Probably the one thing holding back telemedicine use was the refusal of insurers, especially Medicare and Medicaid, to pay for such visits. These visits take the same, if not occasionally more, of the physician’s or mid-level provider’s time. Reimbursement, when given, was less than the equivalent amount of time for an office visit.
With the onset of COVID, insurers were forced to accept the value of telemedicine, given the lack of options if as many people were to be seen as before the pandemic. As an emergency measure, tele-visits were being approved. They still are, even when an in-person option exists.
I and multitudes of people, from the President of the United States on down, have tried to convince people to get vaccinated when they are eligible, and to maintain basic public health precautions; wearing masks properly, washing hands and surfaces frequently, and maintaining social distance. Only about 60 percent of the adult population has followed these recommendations and a similar percent say they will get vaccinated.
If this continues, we may never get to go back to things the way they were, because enough of the population will remain vulnerable and the virus will still circulate and mutate. Once it mutates enough, it will defeat the immunity provided by most of the vaccines.
So, to the people who refuse to follow the best practices to eliminate COVID as a continued threat to normal, social, life, if you are not going to get the shot for some reason you picked up through rumor, learned on the internet or because of political position, maybe you will try to protect yourself, friends and family. If not, it is hurting you where it really matters, in the wallet.
There comes a time in the history of an epidemic when the risk of discomfort, disability and death begins to be outweighed by the risks of continued isolation and continued restrictions on normal societal behavior.
If we can stay the course on the rate of vaccinations that we’ve seen lately since the mega-sites opened, we can soon reach that point. The CDC has indicated that if all the individuals in a space have been fully vaccinated, they can congregate in small groups and without masks with very low risk of illness.
This also assumes we are beginning to reach a level of herd immunity so that the risk of a person who is infected coming into contact with a person who has no protection is decreased solely by the numbers of safe people around them.
The CDC has recently changed its guideline regarding distance that schoolchildren must stay apart. It is been reduced from 6 feet to 3 feet somewhat with the comment that the extra 3 feet doesn’t really matter much. It doesn’t mean that there’s a decreased risk of communicability, it just means that the distance between masked children may be decreased.
There is also a consideration of increased damage to the population from the isolation of individuals from normal society.
Despite the chilling toll – 3,483 COVID-19 cases and 54 deaths – Otsego County people, our neighbors, friends and family, have a lot to be proud of as we ended The Year of The Pandemic on Monday, March 15, we found in revisiting the last 52 editions of this newspaper.
Throughout, there was worry, dismay and grief in the face of the implacable and mysterious foe, but little panic. In reviewing the newspapers, there was, and is, much determination, focus and purpose among our neighbors and our community leaders.
At the county level, board Chairman David Bliss promptly issued an emergency declaration on Friday, March 15, 2020, that outlined many of the steps that have marked our lives since then. Going forward from there, the county board was tough and visionary in the face of disappearing sales- and bed-tax revenues.
The reps laid off 59 FTEs, no fun for anyone. Then – guided by county Treasurer Allen Ruffles – they assembled a plan based on historically low-interest loans and fast-tracking roadwork, which the state CHIPS program still reimburses, to ensure solvency. When President Biden’s $11 million stimulus allocation was announced in recent days, it was appreciated at 197 Main, but not essential.
On a parallel track, county Health Department rallied under Public Health Director Heidi Bond, doing the COVID testing and contact tracing that – along with masks and social distancing – have been central in controlling the disease to the extent we have.
She was already heralded as this newspaper’s 2020 Citizen of the Year, but not enough appreciation can be expressed to her team’s hard work and accomplishment.
This past weekend Bassett performed an amazing feat of vaccinating a large group of people, more than 1,100 over two days. The confirmation of vaccine availability only came though on Wednesday, March 3, leaving but two full days to prepare. Nevertheless, I visited on Sunday and it had the appearance of a military operation (which in a sense it was).
The Bassett community, from Dr. Tommy Ibrahim on down should be proud, as should the staff of the Clark Sports Center, which hosted the event.
I want to especially commend the Bassett Director of Network Pharmacy, Kelly Rudd, Pharm.D., who was in command of the clinic from planning through implementation.
She worked from the list of patients from the state, a list of patients from Bassett’s own scheduling system, and an ad hoc group of volunteers who worked to contact and track down people qualified to be vaccinated, but for whom the computer-driven scheduling system was difficult or even impossible to use.
Also, many thanks are due to the Bassett staff who took the time to make hundreds of calls to help schedule seniors 65+.
There are many reports of computer-savvy individuals signing up friends, family members, and neighbors for vaccine appointments. To see this community spirit and kindness is a great thing.
The clinic was also able to smoothly access the waiting list to make sure no dose went unused. The volunteer group – which went out and identified about 175 people who had difficulty finding appointments on their own – included church members, other faith-based organizations, philanthropic NGOs (non-government organizations) including the Community Foundation of Otsego County, and additional individuals.
Many had been working on an individual basis, but recognized the synergy of working together.
This past Sunday the Director of the CDC (Centers for Disease Control and Prevention) approved the use of the COVID-vaccine produced by Janssen/Johnson & Johnson. The day before the FDA determined that the vaccine was safe and effective for the prevention of COVID-19 and gave it an EUA (emergency use authorization).
On Monday, the state Task Force unanimously recommended its use.
The entire current inventory of 3.9 million doses is scheduled to ship this week. J&J says it plans to manufacture enough additional doses to ship 16 million by the end of March. New York State is supposed to receive somewhere between 93,000 doses and 160,000 this week depending on whether you believe the Feds or the state. In any event, this is very good news.
There have been some concerns from some people; two called me today. They are concerned that this vaccine is not as effective as those already approved. They want to know if they should get the J&J vaccine now if available, or wait to get either the Moderna or Pfizer one.
This marks the 50th column I’ve written in this series.
It’s hard to believe on many levels: How long we have been restricted or locked down, that I am still doing this weekly when we figured we would need to do this for at best a few months, that there remain new things to write about (in fact, every week brings new information), that my publisher makes me pay for my own subscription.
I am very grateful to my readers who have given me useful feedback, my publisher for giving me a forum to spread this information, and to my daughter who is a real scientific editor and has helped me with advice and, at times, review of my work.
In celebration, I’ve decided to write a column with good news for a change. (This is NOT to mean that we don’t still have to be vigilant, maintain masks and social distancing, avoid crowds, etc.)
Just that there’s finally some good news to write about.
►In a study of 600,000 people in Israel, which has vaccinated a higher proportion of its population than any other country, there has been a 94-percent drop in symptomatic COVID-19 infections. The vaccinated group was also 92-percent less likely to develop the severe form of the illness if present.
I was asked to give a talk at the Center for Continuing Adult Learning recently in Oneonta. It was supposed to be on vaccine development and distribution, but two days before I was to give it, I was asked by a participant to address treatment of active COVID-19.
Up to this point I have avoided discussing this because each physician chooses treatment for each patient based on many factors, including recommended protocols, approved medications, and most important, consideration of each patient as an individual.
Nonetheless there is some general advice from the NIH (National Institute of Health).
The NIH divides severity levels for COVID-19 into five parts with their recommendations.
►ONE: Not hospitalized, mild to moderate COVID-19.
There is insufficient evidence to recommend for or against any specific antiviral or antibody therapy.
SARS-CoV-2 neutralizing antibodies are available for outpatients who are at high risk of disease progression.
Antibodies bind to the virus, block its ability to get into a cell, and trigger a response from white blood cells to come and attack the virus.
Antibodies could be natural or manufactured. Dexamethasone is a steroid anti-inflammatory which is approved in more severe stages and should not be used here.
►TWO: Hospitalized but does not require supplemental oxygen.
Dexamethasone should not be used. There are insufficient data to recommend for or against the routine use of Remdesivir. (Remdesivir is a drug specifically to treat viral diseases). For patients at high risk for disease progression, the use of Remdesivir may be appropriate. (Yes, I too find this statement very confusing.)
►THREE: Hospitalized and requires supplemental oxygen, but does not require high-flow oxygenation, mechanical ventilation, or an ECMO (extracorporeal membrane oxygenator – sort of like a heart/lung machine used in open heart surgery).
Use one of the following three options: Remdesivir for patients who require minimal oxygenation, Dexamethasone and Remdesivir for patients who require increasing amounts of supplemental oxygenation, or Dexamethasone alone when combination therapy cannot be used or if remdesivir is not available.
►FOUR: Hospitalized and requires oxygen through a high-flow device or non-invasive ventilation. Use one of the following options; dexamethasone or dexamethasone and remdesivir.
►FIVE: Hospitalized and require mechanical ventilation or ECMO. Use dexamethasone.
There are other drugs that have been considered for use in COVID-19.
One is Invermectin. Others are monoclonal (all one type) antibodies as described above. Another drug fluvoxamine (Fluvox) is a drug used for obsessive-convulsive disorder and was hypothesized to block excessive inflammatory reactions.
Bottom line if sick is, find a physician who you trust. A good physician will listen to a patient’s concerns and questions and then when you are comfortable with them, your best shot is to follow their instructions.
On Friday, Jan. 29, Janssen/Johnson & Johnson announced its vaccine had proven effective in Phase 3 studies. This brings a third vaccine on line in the fight against COVID-19 and potentially increases the pace of vaccinations by 50 percent.
Additionally, the J&J protocol is for a single dose and the storage requirements are much less stringent than those of the two vaccines already available in the United States, Moderna and Pfizer.
On the other hand, the statistics on efficacy for the J&J vaccine are not as high as those reported for the other two. It is reported as 85 percent effective globally against severe disease and 70
percent effective against moderate to severe disease.
Many scientists consider this on balance very good news.
If we remember back to last year the goal for efficacy was 70 percent which would have made that equivalent to the flu vaccine. Only because of higher numbers with Moderna and Pfizer do 85 percent and 70 percent seem low.
Furthermore, the J&J vaccine is a one-dose regimen and requires only basic refrigeration to last for weeks, making it much easier to distribute and complete a course of vaccine (i.e., only one shot).
This should especially help in people hesitant to get a shot at all.
I had my first COVID-19 vaccination Sunday, Jan. 26. To get an appointment, I went through all the protocols and algorithms that I discussed previously in this column.
I was able to find an appointment Sunday in Plattsburgh. A day later I found an appointment for Utica on Feb. 3 and canceled the Plattsburgh appointment and then I kept looking for something closer and sooner.
Lucky for me, some close friends were also going through the various procedures and last Friday, Jan. 24, they found Kinney Drugs in Richfield Springs was scheduling appointments for the next two days; this past weekend.
They had just scheduled theirs and immediately called me and told me about it.
I went online, followed the protocols, and filled out forms. I put in a request for an appointment for Saturday, and up popped my appointment, assigned to Sunday.
I have no complaints. In fact, that system worked better than the state system inasmuch as it asked you when you wanted an appointment but, regardless, apparently gave you the next available.
If the appointment you asked for was already taken by the time your request went in, you’d still get one without having to reenter all that information.
Unfortunately, the state Department of Health’s online registration requires you to put in a great deal of information, then you pick the time from what you saw earlier in the process, and if the appointment that was in that spot had already been taken by somebody else while you were doing the application, you have to go all the way back into the beginning to try and find next available appointment.
By RICHARD STERNBERG • Special to www.AllOTSEGO.com
If you’re like me, and I only mean that in the COVID-phobic sense, you have been trying to figure out how to get vaccinated. I have been on-line an average of an hour a day for about two weeks trying to find appointments. Then I heard on the news that the New York State vaccination site at Jones Beach (Long Island) now has a three-month wait. What to do?
Two weeks ago, I wrote about the priorities that the state, i.e., Governor Cuomo set out. 1A was to be healthcare workers on the frontlines and nursing home residents, 1B was to be essential workers, 1C was to be people over 65 and high-risk individuals.
Then it changed, and changed again.
Every state has its own priority system. Doses have gone unused. People are flying to Miami just to get vaccinated (and maybe a little sun while they are there).