Stay well, Friends of TVD,
What a disquieting week, and what dystopian skies. A reinforcing message regarding the wisdom of masks? Read more about masks below, and for now join Team TVD in missing the typical blue skies of California summer.
Many of you have asked about this year’s flu vaccine, and yes, it is more important this year than ever to get your flu shot. That said, The Village Doctor is eagerly awaiting our vaccine shipments which will be arriving soon. Please note, in order to efficiently communicate with our patients, including our more “at risk” patient groups, it is important that you have your Elation Passport PORTAL active and available to you, as it is our preferred way to message our patients. Please check that your username and password work! (This is also a great time to double check your medical history and medication lists). If you need help getting your Elation Passport Portal to work, please give Andrea, our Front Desk Concierge, a call.
Also important, I want to draw your attention to the CETF, or COVID-19 Early Treatment Fund, founded by TVD friend and entrepreneur, Steve Kirsch. Like many people, the pandemic hit the Kirsch family hard. Steve is in a high-risk group for serious COVID-19 infection and cannot safely resume his normal life until there are proven treatments that prevent COVID-19 deaths. He recognized just how many people have underlying conditions that put them at risk for serious illness and death from the virus, and he found that fact unacceptable. Combine the medical risks with the financial hardships experienced by families and businesses everywhere, and it became clear that waiting for a long-term solution like a vaccine was not an option. This big problem required immediate action. Luckily, Steve likes solving big problems… I strongly encourage you to read more here, or simply watch this CETF Video. And share!
(Eric Weiss, MD, September 9, 2020)
NOTE: CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.
WHAT DO WE KNOW ABOUT THE CDC’S COVID-19 VACCINE PLANS?
The CDC told public health agencies last week to begin preparing for distribution of limited doses of vaccine as early as late October. President Trump’s vaccine chief, Dr. Moncef Slaoui, said on Thursday he believes it is “extremely unlikely but not impossible” that a vaccine will be available by late October but that it makes sense for public health agencies to prepare just in case. Replying to whether the timing of the vaccine might be motivated by political concerns, he clarified that the two main candidates, developed by Pfizer and Moderna, will only complete trials when an independent safety monitoring board, separate from the government, affirmed the effectiveness of the vaccine. In an interview with NPR, Dr. Slaoui did say he firmly believes there will be a vaccine available before the end of the year, probably on the order of 20-25 million doses, with enough to vaccinate all of the US population available by mid-2021. Who will have priority access to the first doses? In the documents sent to public health agencies, the CDC said certain groups would have priority, beginning with health care workers and essential workers in critical industries. With about 17 to 20 million health care workers, 60 to 80 million essential workers and about 53 million people older than 65 in the US, the majority of the US population under age 65 is looking at early to mid-2021.
(Jennifer Abrams, MD, September 7, 2020)
WILL THE COVID-19 VACCINE BE AVAILABLE FOR CHILDREN AND PREGNANT WOMEN?
There is some hope that a vaccine will be available for essential workers by the end of this year (see “What do we know about the CDC’s COVID-19 vaccine plans” above) and for the elderly in the spring of next year, however it is likely that children and pregnant women will have to wait quite a while longer before the vaccine is approved for them. As is normally the case, experimental vaccine trials start with the population deemed to be at lowest risk, should side effects occur — in this case, that is “healthy adults” under 65 years old. Usually the elderly population is excluded because of their higher risk for side effects, however as the clinical trials have progressed, those over 65 have actually been included given their known risk of more severe COVID-19 disease.
So far pregnant and breastfeeding women have not been included in clinical trials and only one of the potential US vaccine makers, AstraZeneca, has started to test its vaccine in kids. In June, when the FDA laid out their guidance regarding COVID-19 vaccines, they stipulated that animal studies should be done first to assess developmental and reproductive toxicity. As of now, only one of the manufacturers, Pfizer, is conducting those trials, but other experts feel it’s only a matter of time. One of the leaders of the NIH’s COVID-19 Prevention Network, Larry Corey, said that ensuring the vaccines are safe for pregnant women “is of major importance” and that “discussions are underway to discuss plans for initiating studies in children.” In fact, outside of the US there are two clinical trials underway in China open to children over 6 months old and one in India allowing 12-65 year olds to enroll (no results have been published yet.) The Oxford-AstraZeneca trial (in Phase 2/3) is testing the vaccine’s safety in kids aged 5-12. Michael Osterholm, the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, says “There’s going to be a huge push to vaccinate children because of schools… so we can open schools more safely” and hopefully keep them open. We remain cautiously optimistic that safe and effective vaccines are available for prime time on the estimated timeline and that vaccines for pregnant women and children won’t lag too far behind. Read more here.
(Jackie Phillips, MD, September 8, 2020)
DOES WEARING A MASK MAKE GETTING A SEVERE COVID-19 INFECTION LESS LIKELY?
The short answer is YES. Epidemiologists and most scientific agencies agree that wearing a mask significantly lowers the spread of virus by reducing one’s own droplet spread.
The other reason is that new data published in Tuesday’s issue of the New England Journal of Medicine suggest that wearing a mask can also potentially reduce the severity of illness if you are exposed to someone with the COVID-19 virus.
Dr. Monica Gandhi and Dr. George Rutherford, infectious disease specialists at UC San Francisco have studied this idea and propose that “masks cut down the amount of viral particles flying around — so if you’re infected, you’ll get a lower dose and less severe symptoms,” said Rutherford. Studies show that masks may not filter out all droplets — a mask’s filtering capacity is determined by its type — and it’s still possible for the virus to sneak through, but at a lower dose than for someone not wearing a mask at all.
Dr. Gandhi and Dr. Rutherford referred to studies done in hamsters living in mask-covered cages showing lower incidence and severity of illness from COVID-19. In addition we have recent information from countries such as Taiwan, South Korea and Thailand, where mask wearing was commonplace, that show markedly lower numbers of total infections and severity.
This is indeed very important as many of us find ourselves with mask fatigue. If you can protect others and also reduce your own potential infection, all the more reason to wear a mask that fits you well.
(Prerana Sangani, MD, September 9, 2020)
HAVE WE LEARNED MORE ABOUT AIR TRAVEL AND CORONAVIRUS? IS IT SAFE?
For Bay Area residents with relatives nearby, visiting during the pandemic comes with extra precautions: masks, backyard meals with physical distancing, and no hugs or handshakes. But for those with loved ones a flight away, the decision is more complicated. It means considering the threat of infection while flying versus the pain of missing funerals, births, and graduations. And considering your own infectious threat to those you are visiting and how much of a quarantine to self impose.
Airline travel has changed dramatically over the last 6 months, with international airlines operating just 2-4% of their usual number of flights, and most domestic airlines limiting capacity (although often by only 30%). To lure travelers back, airports and airlines are taking measures to mitigate risk, like adding physical distancing markers, providing masks, using new cleaning procedures, implementing boarding protocols, and suspending food and beverage service to minimize contact between crew and passengers. Mask requirements have now finally been enacted by all major airlines. And on United, Delta, and JetBlue, those not complying are added to a No-Fly list and banned for a period of time.
“Flying is an accumulation of a bunch of things that in, general, imply higher risk,” says Dr. Bob Wachter, chair of UCSF Medicine, in a June SF Chronicle article . “It is staying in fairly close contact with a whole lot of people you don’t know, it is doing that indoors, it is doing that for long periods of time.” There’s the ride to the airport, security lines, using a public restroom, buying a snack and walking down the jetway to board — a process bringing you in contact with strangers and the surfaces they touch every step of the way. None is particularly dangerous on its own, but each adds to the overall chance of exposure.
And there is reason to be nervous. A study published August 18th discovered two passengers who likely acquired COVID-19 on a 4 hour flight from Tel Aviv, Israel, to Frankfurt, Germany, carrying 102 passengers. On that flight was a tourist group of 24 people who had been in contact one week earlier with a hotel manager, later diagnosed with COVID-19. Seven of those tourists tested positive for the virus upon arrival in Frankfurt — as eventually did two passengers who were seated within two rows of them. None wore masks during the flight.
This study is somewhat unique in that health authorities from both countries successfully followed all involved individuals and completed thorough tracing protocols. Similar data is limited for most flights. But there are some data and case studies available, and they seem to suggest a low infectious risk from flying. Specialists in air travel and disease agree with this reassuring, albeit preliminary, perspective.
In the NPR interview with Dr. Lin Chen, an infectious disease and travel medicine doctor, and president of the International Society of Travel Medicine, she said a review of the available data, although varied, showed that the overall rate of infection from air travel is “very, very low.” She points to a January flight from China to Canada and another flight from New York to Taipei, each with one symptomatic COVID-19 passenger who did not infect anyone else on board.
Researchers theorize several reasons for this: deliberate underbooking by airlines, masks and symptom-checks, or just really insanely efficient ventilation systems present on most modern airplanes (15-20 HEPA-filtered air exchanges per hour). But Dr. Chen emphasizes that we don’t really know, “Testing may have been suboptimal in January [to] March, and we may have missed some cases that were acquired in-flight.” Or perhaps the low numbers simply reflect the low volume of travelers. If passenger volume increases and airlines add back flights, Chen says we may see more cases and exposures, especially as testing access improves.
If you do fly: Smart precautions for air travel
* Minimize contact: look for an airline that has blocked middle seats, fly at less crowded times, book a window seat so you’re in proximity to fewer people during the trip.
* Carry on: the fewer people who touch your bag the better.
* BYO-everything: bring your own snacks and water bottle.
* Sanitize: TSA allows up to 12 oz of liquid hand sanitizer in carry-ons. Clean your hands every time you touch a public surface.
* Avoid the tiny airplane bathroom: go before you board.
* Wipe down: bring alcohol wipes to give your seat area a thorough cleaning.
* Mask up: wear a mask the entire time, and notify flight attendants if others are not wearing theirs. Add a face covering like a plastic shield for even more protection.
(Sky Pittson, MD, September 2, 2020)
If you have made it this far, time for a reward, something to lighten your day, and acknowledge the human spirit. Find some escape, or perhaps even inspiration, in this ever growing collection of works and perspectives gathered from around the world. Please contact me directly if you have come across something that has lifted your heart today. Dr. Eric Weiss
I’d like to give a shout out to Dr. Jeanne Rosner and our friends at SOUL Food Salon who have recently partnered with Off Their Plate, to support the Bay Area communities and underserved populations most impacted by COVID-19. Off Their Plate (OTP) is a volunteer-run grassroots organization, which was founded in the midst of our current pandemic. The new organization already has a presence in nine major cities across the US. OTP delivers nutritious meals to frontline healthcare workers and food-insecure families, while also providing economic relief to COVID-19-impacted restaurant employees.
One hundred percent of donations go to OTP’s local restaurant partners. Every $100:
- Provides 10 meals to healthcare workers or to people experiencing hunger and
- Restores three shift hours to the local economy through the OTP restaurant partners.
Click here to make a contribution to Off Their Plate. Your donation will help feed healthcare staff, provide a lifeline to food-insecure families and benefit restaurant workers during this time of crisis.
Click here to see a short video about Off Their Plate.
Again, CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.
*****
Yours, in health and resilience,
Eric and the TVD MD team…
