coronavirus

Local Covid Update as of 7-15-2021

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The Delta variant of Covid-19 is responsible for a dramatic increase in Oklahoma’s cases of and hospitalizations for Covid-19.  The cause of more than half of all new Covid-19 infections in the state, this variant is 4 times more contagious than the previous strains and causes more severe disease, especially in younger patients and in pregnant women.  Nationwide, new cases have risen 109% in the past 14 days and deaths are up 17%.

            67% of fully vaccinated persons, whether they received the Pfizer, Moderna or Johnson and Johnson vaccine, are safe from infection with all known variants, leaving 33% susceptible to reinfection.  Fortunately, the fully vaccinated who develop Covid-19 infection almost always experience mild disease lasting 5-10 days and rarely end up in the hospital.

            Let’s look at the numbers for Oklahoma.

·       In the past 14 days, there has been a 53% increase in Covid-19 related hospitalizations.

·       2,688 new cases were reported in the past week, a 56.7% increase from the week of June 27-July 3.

·       11 deaths were reported in the past week.

·       The average age of cases was 40 years, much lower than during last winter’s spike, and 67% of the cases were in patients younger than 50.

·       As of July 12th, 45.7 % of Oklahomans had received at least 1 dose of the vaccine, and 39% were fully vaccinated.

·       As of July 12th, in the 12-17 year-old age group, 17.1% had received at least 1 dose of the vaccine, and 12.7% were fully vaccinated.

·       As much as 95% of new cases are occurring in unvaccinated persons.

Next, some Tulsa information:

·       Local hospitals are seeing increased numbers of emergency department visits, admissions, ICU admissions, and ventilator use involving Covid-19 patients.

·       The number of inpatients in Tulsa has increased fourfold in the past 6 weeks.

Clearly, Oklahoma has a long way to go to reach herd immunity, estimated to occur when about

72% of the population is fully vaccinated.  Until then, the Delta variant, and perhaps new ones yet to come, will continue to develop and spread.  For all our sakes, we all need to get fully vaccinated and encourage our unvaccinated friends and family to do the same.

 

Why Herd Immunity Alone Is NOT a Viable Option for Eradicating COVID-19

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As discussed in an earlier blog, herd immunity occurs when enough people become immune to an infectious disease, either through infection or a vaccine.   A virus will die out once uninfected individuals are rarely in contact with those that are contagious.  But achieving herd immunity by natural transmission and without a vaccine is gained at the cost of many lives.

In August, the World Health Organization’s Michael Ryan warned journalists, “We are nowhere close to the levels of immunity required to stop this disease transmitting.  We need to focus on what we can actually do now to suppress transmission and not live in hope of herd immunity being our salvation.”

Experts believe that 60-70% of Americans will need to become immune before our country reaches herd immunity.  But, according to Dr. Dale Bratzler, OU Medicine enterprise chief quality officer, “Getting to herd immunity through infection is not the direction Oklahoma wants to go right now.”   To get there, nearly 2.4 million Oklahomans would have to contract COVID-19.  Using the lowest available estimate of case fatality rate of 0.3%, this would mean more than 7,000 Oklahomans (more than ten times the current total) would die, while using the state’s current 1.27% death rate means that more than 30,000 people would die.

It is believed that, even in the absence of a vaccine, the Brazilian city of Manaus has reached herd immunity.  As of August, researchers estimated that 66% of the population had been infected.  In that city of over 2 million people, 4,000 people have died so far, a high death toll for a city where only 6% of the population is over 60.  This experience reveals “that an unmitigated outbreak will lead to very significant levels of illness and mortality,” says Bill Hanage, an epidemiologist at Harvard University, “which is what we’ve been saying since February.”

So, the consensus opinion of experts, with which I also concur, is that we do need to achieve herd immunity against COVID-19 through a combination of natural immunity due to infection AND an aggressive vaccine program.  And, while awaiting the arrival of COVID-19 vaccines, we all need to continue to wear masks, wash our hands, avoid touching our faces and maintain social distancing when appropriate.  Frequent testing and contact tracing are also needed for those who have been exposed to COVID-19.  If we do these things we will save thousands if not millions of lives.

For more information check these links

https://www.thelancet.com/journals/lancet/article/PIIS0140-67362031924-3/fulltext

https://www.inquirer.com/health/coronavirus/covid-coronavirus-herd-immunity-vaccine-20200924.html

COVID-19 in Children, Teens and Young Adults

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Children and teens can get COVID-19.  While most have mild symptoms or none at all, these groups can spread the virus that causes COVID-19 to others, including older adults,  who may be more susceptible to its effects.  And children can get severely ill, and may require hospitalization, intensive care or even the use of a ventilator.  

Who’s most at risk of acquiring the infection?  The highest risk of infection is in communities with a sizable outbreak, when people spend long amounts of time in closed, unventilated spaces where other people close by are talking or otherwise emitting virus-laden vapor, and  where people aren’t wearing masks. 

Severe illness from COVID-19 is more likely if affected youth and young adults have:

  • Asthma

  • Diabetes

  • Genetic, neurologic conditions

  • Heart disease since birth

  • Immunosuppression (weakened immune system due to certain medical conditions or being on medications that weaken the immune system)

  • Medical complexity (the presence of multiple chronic conditions that affect many parts of the body and require technology and other significant supports for daily life)

  • Obesity

Infants and young children can develop a serious condition known as multisystem inflammatory syndrome that can affect the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

Young adults age 18-34, in whom the numbers of COVID-19 cases have been rising rapidly, are also at risk for complications from COVID-19, especially if they fall into one or more of the groups detailed above.  When young adults are hospitalized due to symptoms of the infection, 21% require ICU admission, 10% require mechanical ventilation (the use of a ventilator) and 2.7% die.

Young adults are also more likely than children or adults 65 and older to develop prolonged, post COVID-19 infection symptoms.  Termed “long-haulers,” these patients can suffer from a diabolical grab bag of symptoms, including chronic fatigue, shortness of breath, unrelenting fevers, gastrointestinal problems, lost sense of smell, hallucinations, short-term-memory loss, bulging veins, bruising, gynecological problems, and erratic heartbeat. 

Symptoms of Covid-19 are similar in all age groups and include:

  • Fever

  • Cough

  • Shortness of breath or difficulty breathing

  • Fatigue (tiredness)

  • Sore throat

  • Runny or stuffy nose

  • Muscle pain or body aches

  • Headache

  • Vomiting and/or diarrhea.

  • Significant loss of taste and/or smell

If you think you might be infected with COVID-19 seek medical advice about testing and treatment.

COVID-19 affects all age groups, can be mild or deadly at any age, and can cause prolonged symptoms even after recovery from the acute illness.  Our best current protections are to wear masks when appropriate, avoid crowds, wash our hands frequently, avoid touching our faces and maintain social distancing in public.  The use of vaccines that will become available in the coming months will greatly help to further mitigate the spread of this disease.

For more information: 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/symptoms.html

The Oklahoma State Medical Association Urges Caution, Common Sense to Prevent Spread of COVID-19 at Large Gatherings

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Oklahoma City (June 17, 2020) – While the state gears up for more large events, including Saturday’s campaign rally for President Trump, the Oklahoma State Medical Association is urging people to use caution and common sense to decrease infection spread during public gatherings. The medical community’s concern is prompted by recent COVID-19 spikes throughout Oklahoma, some of which have been traced to large gatherings and a loosening of public health restrictions as Oklahoma completes its final phase of re-opening.

As Tulsa prepares for the upcoming Presidential visit, the state is dealing with a significant spike in the number of positive coronavirus cases. In fact, the Oklahoma State Health Department has reported almost 1,300 new cases this past week alone. Over the weekend, public health officials in Tulsa implored event organizers to reconsider hosting large gatherings that could contribute to even more disease spread.

“Though the desire to participate in the political process is commendable, it is certainly our hope that state and national leaders will heed the warnings of the public health community and work with both Mayor Bynum and the Tulsa County Health Department to find ways to mitigate health risks while preserving the right to peaceably assemble. This could include moving the venue outdoors, having multiple smaller venue events, and having a virtual attendance option” said George Monks, M.D., president of the Oklahoma State Medical Association. “However, if events like these are going to proceed, we strongly encourage those who choose to gather to implement common- sense measures, such as wearing face masks, maintaining as much distance as possible from others and using hand sanitizer or washing frequently. In addition, the duration of such events should be kept to a minimum in order to lower possible risk of virus transmission.”

In addition to addressing the need for caution surrounding large events, Dr. Monks also called for Oklahomans to help prevent the everyday spread of coronavirus by embracing common-sense guidelines from the CDC, which include wearing masks in public and cleaning hands frequently.“

The climb in positive numbers over the six weeks since the state began reopening have shown that this virus is still very active. While it is necessary for Oklahomans to leave the house for shopping, doctors’ visits and work, it is also important to be mindful not only of your own health but also that of those in your community. When faced with overwhelming odds, Oklahomans work together for the betterment of our communities, emerging from crisis even stronger than before. This weekend, the eyes of the world will be on Tulsa, and this is our opportunity to once again embrace the Oklahoma Standard by working together to protect the health of our fellow Oklahomans.”

The state’s largest physician advocacy group, the Oklahoma State Medical Association represents over 4,000 physicians, residents and medical students.

Media Contact: Jennifer Dennis-Smith dennis-smith@okmed.org 405-412-2540

Coronavirus Testing

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What about testing for Covid-19 infection?  Our local, state and national leaders have all called for more Coronavirus testing, but what do the tests mean and how can they help?

There are two basic type of Coronavirus tests, the nasopharyngeal swab (NPS) and antibody testing.  The NPS is a deep nasal swab that uses a method called polymerase chain reaction to amplify even a very small specimen and allow analysis for the presence of viral particles.  This allows the identification of active or very recent Covid-19 infection with impressive accuracy.  Our lab provides the results in about 24-36 hours.

Antibody tests are fingerstick or blood draw specimens that measure immunoglobulins--proteins  that our bodies make in response to infections, allergies, vaccines or foreign substances.  It takes 1-3 weeks after the symptoms of an infection appear before our bodies produce measurable levels of antibodies, including antibodies to Covid-19 infections.

So, who should be tested, and how?  If you suspect acute infection with Covid-19 and you want to be sure, the best test is the NPS, because this test will tell you if you have active infection and if you are likely to be contagious.  If you want to know if you have already been exposed to Coronavirus, then the antibody test is best.  And if you suspect that you have recovered from a Covid-19 infection, the antibody test can confirm prior infection and make you eligible to donate convalescent plasma (the portion of the blood rich in antibodies) that can be used to treat patients who are very sick with the disease.  Many patients with mild disease may not need to be tested, but if you suspect infection you should contact your doctor for advice about self-isolation, quarantine and other treatment issues.

If you have questions about which tests are right for you, call your doctor.   I can arrange testing at my office for any of my patients.

Remember, wear a mask, wash your hands, and don’t touch your face!  Let’s work together to minimize the impact of Covid-19.

Ask Dr. Laughlin: "Can coronavirus infect through the eyes?"

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The coronavirus (Covid-19) is a highly-contagious respiratory virus that is most commonly transmitted by the droplets of saliva and mucus that are generated by coughs, sneezes, talking and singing.  These infected droplets can then enter an uninfected person’s mouth or nose, where Covid-19 can attach to the cells of the respiratory tract and initiate infection.  Covid-19 can also spread when an uninfected person touches a surface on which Covid-19 is present and then touches their mouth, nose or face.

What about the eyes?  Both the American Association of Ophthalmologists and a group of researchers at Johns Hopkins University believe that Covid-19 can enter the body through the conjunctiva, the moist cells covering the eye.  Once Covid-19 has entered the eye, it may cause the local inflammation/infection called conjunctivitis, or “pink eye,” and/or spread via the tear ducts to the nose and mouth, where more serious infections can occur.  While spread through the eyes is the least likely means of transmission, this is still a possible way to catch Covid-19.

Experts recommend that, in addition to masks gowns, and gloves, the personal protective equipment, or PPE, used by healthcare workers when treating potential Covid-19 infections should include eye protection such as face shields and goggles that protect the front and sides of the eyes.  Wearing ordinary glasses is not enough.

With Covid-19, you cannot be too careful.