covid-19

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.

 

Does Covid-19 Infection Confer Immunity?

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The immune system can retain a memory of infection long after a person recovers from a viral illness.  Immune cells and proteins that circulate in the body can identify and kill the virus if it is encountered again.  

Long-term immunity depends upon several components:

  • Antibodies, circulating proteins in the blood, recognize viruses and destroy them.

  • Killer T cells, a type of lymphocyte, recognize and kill pathogens including viruses.

  • B cells make new antibodies when needed.

A recent study by Washington University researchers, published in the journal Nature, suggested that mild cases of Covid-19 leave lasting antibody protection and that repeated infections of Covid-19 are unlikely.  B cells multiply rapidly during infection, but, as patients recover, most B cells die off and blood antibody levels drop.  Some B cells, known as long-lived plasma cells, remain in the bone marrow, secreting antibodies, and are ready to respond against a new exposure.  These plasma cells will likely confer lasting immunity.

In a recent study at the National Institutes of Health that analyzed Covid-19 cases of varying severity, 95% of participants had 3 or more of the 5 immune-system components studied when measured for up to 8 months after infection.

Based upon these results, it appears that Covid-19 infection does confer lasting immunity in most infected individuals.  Both groups of researchers agree that it remains to be seen if vaccination also induces the immune responses needed to provide long-term immunity.  Vaccine-related studies are ongoing.

Covid Update

According to the Centers for Disease Control and Prevention (CDC), the US is seeing a drop in Covid-19 cases and deaths.  As of May 10th, the US has noted a total of 579,945 deaths attributed to Covid-19. But the 7-day moving average of daily deaths has fallen from 3095 on January 20th to only 608 this week.  If vaccinations remain high and simple mitigation measures —wearing masks and maintaining social distance when appropriate, and washing hands—are used, then this number should continue to rapidly decline.  

During a recent White House Press briefing, CDC Director Dr. Rachel Walensky said that these projections tell Americans, “We have a path out of this.”  Walensky continued, “Although we are seeing progress in terms of decreased cases, hospitalizations and deaths, variants (new forms of Covid-19 with slightly different genetic makeups) are a wild card that could reverse the progress we have made.”

The main three current variants include B.1.1.7 (UK Variant) 60%, B.1.526 (Brazil Variant) 9% and P.1 (Brazil Variant) 5%.  While all three variants pose higher risks of contagion and severity of disease, Walensky stated, “We are seeing that our current vaccines are protecting against the contaminant variants in the country.  Simply put, the sooner more and more people get vaccinated, the sooner we will all get back to normal.” 

This week the CDC issued emergency use authorization approval of the Pfizer vaccine for youths age 12-15, which should extend immunity to millions more Americans and help achieve herd immunity.  Herd immunity will be reached when 80% of the population are vaccinated or immune due to recovering from the disease, at which time the likelihood of the unvaccinated catching the disease becomes very low.  Currently nearly 60% of adults have received at least 1 vaccine dose and approximately 44% have been fully vaccinated.   By adding this new group of youths, and continuing to vaccinate more adults,  the US will get closer to herd immunity and also help control the development of new and possibly more dangerous variants.

For more information, visit these links:

https://www.cnbc.com/2021/05/05/cdc-projects-a-surge-in-us-covid-cases-through-may-due-to-bpoint1point1point7-variant-before-a-sharp-decline-.html


https://edition.cnn.com/2021/05/05/health/cdc-model-covid-19-cases-study/index.html



What to Do While You Await a COVID-19 Test Result

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From the OKLAHOMA State Department of Health

Released December 16, 2020

What was the reason for COVID testing?

1. If you have symptoms consistent with COVID:

• Stay home and away from others while you wait for your test results.

2. If you have been exposed to someone with COVID but are not having symptoms:

• You should stay home for 14 days from date of last contact with the COVID patient, if possible. If you remain free of symptoms through day 10, your quarantine can end on day 11, but you should continue to monitor

for symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. If you are tested on day 5 after last date of exposure or later, you can end quarantine after day 7 and once you have received a negative test result. You should continue to monitor symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure.

3. If you were tested for surveillance purposes, with no known exposure to COVID, and are not having symptoms:

• If you were tested for an upcoming surgery, flight, travel, or another reason and you do not have a known exposure or symptoms, you do not have to stay home while awaiting results.

If your test is POSITIVE:

• This means you currently have COVID-19. If you have a previous positive COVID test, speak to your healthcare

provider about whether this is the same infection or a new infection. If it's more than 90 days since your last positive test, follow the instructions called "What to do if you test positive or are diagnosed with COVID-19 and

isolate yourself because reinfection with COVID can happen.

• Follow the instructions called "What to do if you test positive or are diagnosed with COVID-19."

• You should notify everyone you were in close contact with during the 2 days before your symptom onset or test date (whichever is earlier) through to the date you are notified of your test result. Close contacts include, but are not limited to: household members and people within 6ft of you for 15 minutes or more. If during that time period, you worked at, or spent time in, a high-risk setting, please notify the facility of your positive test result immediately. Examples of high-risk settings include childcare, school/college setting, healthcare, correctional facility, homeless shelter, long-term care facility, or residential care facility. Work with them to provide a list of your close contacts.

• All close contacts should follow a 14-day quarantine period from their last date of exposure, if possible. There are two alternatives to the 14-day quarantine period. If the person remains free of symptoms through day 10, their quarantine can end on day 11, but they should continue to monitor for symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. If close contacts receive a negative test result from a sampling on day 5 or later after their last date of exposure, then they can end quarantine after day 7. They should continue to monitor symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. Unless you completely stay away from your household members during the 10 days you are infectious, their quarantine period does not start until the end of your isolation {10 days after symptom onset or positive test, whichever is earlier). That means household members could be in quarantine longer than one of the quarantine options listed above.

If your test is NEGATIVE:

• This means you do not currently have COVID-19. However, you could still be exposed or become sick at any time.You should continue to take steps to protect yourself and others from COVID-19.

• If you develop symptoms of COVID-19 or your symptoms worsen, talk to your doctor or other health care

provider about getting tested again.

• If you were tested on day 5 or later from your last day of exposure so you could end quarantine early, you should stay at home until after day 7 from your last date of exposure.

Additional information can be found at Oklahoma State Department of Health COVID-19 Website

https:coronavirus.health.ok.gov/ OR cal! the Oklahoma Helpline 2-1-1 (available 24/7).

Covid-19 and the Heart

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As Covid-19 continues to spread (over 200,00 new cases in the USA each day for the past two weeks) , evidence has mounted that active Covid-19 patients and survivors can experience some types of heart damage.   Heart effects are more likely among men, older persons, and people with diabetes, high blood pressure, known prior heart disease and obesity.   

A recent study of over 44,000 patients with Covid-19 showed that patients with a history of cardiovascular disease were 5 times more likely to die of the virus than patients without this history.  Frequent cardiovascular complications include heart attacks, myocarditis (acute inflammation of the heart muscle), acute heart failure (decreased ability of the heart to pump blood), failure to maintain adequate blood pressure, changes in heart rhythm, and blood clots in veins.   

New evidence suggests that some patients who are not hospitalized and who have not been diagnosed with cardiovascular complications while they were ill may seem to recover from Covid-19 and yet be left with cardiovascular damage and complications.  A recent JAMA study of mostly non-hospitalized patients revealed that 78 percent of patients who recovered from Covid-19 had abnormalities in their hearts and that 60 percent showed signs of ongoing heart inflammation.  

It’s hard to know who’s at risk or how to screen those patients who are recovering from Covid-19 for possible cardiac risks, but if these patients experience increasing or extreme shortness of breath, chest pain, swelling of the ankles, heart palpitations (irregular beats), not being able to lie flat due to shortness of breath, waking up at night short of breath, or unexplained dizziness and lightheadedness they should consult their doctor right away.

Even if there is heart damage related to Covid-19, patients with myocarditis due to other viral infections have recovered without any permanent effects.  Studies are ongoing to determine the best treatments and preventive strategies for heart disease.  Many of these patients already receive dexamethasone (a corticosteroid medication) to reduce inflammation and blood thinners to prevent blood clots from forming.  Because of these and other treatments, the mortality rates from Covid-19 infections are falling.

It has only been a year since Covid-19 was first reported.  Much has been learned and treatments have improved, but we have a long way to go to learn all of the answers.  

Check this link for more information:

https://www.heart.org/en/news/2020/09/03/what-covid-19-is-doing-to-the-heart-even-after-recovery

Corticosteroids and Covid-19

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Cortisol, commonly called the "stress hormone," is a naturally-occurring steroid hormone that is released in response to stress. It is involved in a wide range of processes in the body, such as metabolism, inflammation, blood pressure regulation and bone formation, according to Johns Hopkins Medicine.  Corticosteroids are synthetic forms of cortisol that work by decreasing inflammation and suppressing the immune system, according to Cleveland Clinic.  Left untreated, excess inflammation can damage healthy tissue, as well as cause redness, swelling and pain.

Corticosteroids are important in the treatment of many inflammatory, allergic, immunologic, and malignant disorders

In the October 6, 2020 issue of the Journal of the American Medical Association, 3 recent studies were presented that all agreed that corticosteroids are beneficial in the treatment of patients with severe Covid-19 infection.  Patients requiring the use of ventilators and/or oxygen appeared to derive the most benefit.

An accompanying editorial reviewed the benefits of corticosteroids not only in Covid-19 patients but also in patients with non-Covid-19 adult respiratory distress syndrome (ARDS), a common cause of respiratory failure in hospitalized adults.  Because of the many Covid-19 trials initiated this year, much has been learned about the use of corticosteroids in these critically-ill patients that can generate more research and also hope for many seriously-ill patients.

Corticosteroids are inexpensive and useful in many conditions.  These readily available drugs can immediately be utilized for those Covid-19 patients who need them.  President Trump received the corticosteroid dexamethasone as part of his Covid-19 treatment regimen.

For more information:

https://jamanetwork.com/journals/jama/fullarticle/2770275?resultClick=1