Quick Updates: Covid-19 and Flu

Here is critical information in an abbreviated format about the status of Covid-19 infections and vaccines as well as flu shots that we will start in 10 days:

Covid-19 pandemic

• The current wave of delta variant of SARS-CoV-2 virus continues to ravage much of the south, central, and near-western states where immunization rates are low.
• Massachusetts is doing relatively well, but still has much higher prevalence of disease and hospitalization than we did in the spring.
• We still need to wear good masks (KN95 or surgical are more effective than most cloth masks) when indoors, continue social distancing, and be aware of the high transmissibility of the virus through the air. Indoor restaurants and theatres are unfortunately not a good idea now, nor is long-distance airplane travel.
• While breakthrough infections do occur in fully vaccinated adults, the vast majority of serious infections and deaths occur in the unvaccinated population.

Current Massachusetts Covid-19 mortality data

• SARS-CoV-2 continues to kill people of all ages (again, almost all unvaccinated). The case fatality rate (mortality if infected) in Massachusetts remains amazingly high despite available treatments.
• Data from the Mass.gov website from the two weeks ending 9/25/21 (vaccination status is unfortunately not tracked) show:
  • Daily new cases about 1,000
  • Case fatality rate for everyone over age 30 is: 1.33% (1 in 75 chance of dying of the illness)
  • Case fatality rate for ages 30-79 (exclude very old) is: 0.82% (1 in 122 chance of dying)
  • Case fatality rate in midlife ages 30-69 is: 0.59% (still 1 in 170 chance of dying).
• Remember, these deaths in ages 30-69 are functioning people in the community, your neighbors, healthy or perhaps with some chronic condition being treated routinely by their doctors, but most likely not vaccinated, who go from casually acquired infection to death typically in weeks.
• As a physician, I find these case fatality rates appalling and scary. You should as well.

Vaccines against SARS-CoV-2

• The three vaccines against SARS-CoV-2 — Moderna, Pfizer, and Johnson & Johnson — are all exceedingly safe and effective. These are extraordinary achievements.
• If you have not been vaccinated, get it done to protect yourself, your family, and others. Go to your local pharmacy as soon as possible.
• Prevention by vaccination is the most effective strategy. 

OHC role in Covid-19 vaccine administration

• Last year we had prepared for and applied for Covid-19 vaccines for initial immunizations, but never were allocated any, hence could not help our members with primary immunizations. This was true for most smaller medical practices. We really disagreed with that state policy, but could have no impact on it.
•  We now can request Pfizer vaccine to administer the supplemental doses that were just approved for certain groups. We have requested doses and hope to be able to administer them as part of our upcoming influenza clinics.

Supplemental SARS-CovV-2 vaccine dose status

• The Moderna vaccine is highly effective and durable and a third shot does not appear to be needed, certainly not in next few months. You should not now try to get a third shot.
• The Pfizer vaccine also is highly effective but appears to slowly lose some of its effectiveness over time. A third dose has been recommended for adults over 65 and immunocompromised patients of any age as well as others with various complex medical issues. This is not a crisis.
  • Again, we have requested Pfizer vaccine to dispense and will try to provide that to eligible members during our upcoming flu clinics.
  • Pfizer 3rd shots are also available at drug stores and elsewhere, again to eligible people. You may certainly take advantage of that source.
• Johnson & Johnson vaccine will likely be recommended for a second shot sometime in the next month or two. In that event, we would attempt to get that vaccine to distribute as well. Protection against serious disease remains very good.
• Children’s vaccine (probably Pfizer) will likely be available later this year.

Treatments for Covid-19 infections

• If you think you are sick with or exposed to Covid-19, obviously contact us promptly.
• The Lilly dual antibody (bamlanivimab and etesevimab) infusions, when given in the first 5 days or so of infection, can greatly reduce Covid-19 hospitalization and death. We can help arrange the antibody infusion, which is generally accessible through local hospitals with a doctor’s prescription.
• Additionally, Merck just announced that their clinical trial data show that an oral antiviral they developed (molnupiravir) appeared effective against SARS-CoV-2 in preventing hospitalization and death. That treatment is highly promising, but still needs to be evaluated and approved by the FDA even for an EUA (emergency use authorization) and so is likely several months away at best. We would likely prescribe if and when available.
• The dual antibody infusions (bamlanivimab and etesevimab) have also been under study as preventive for Covid-19 and perhaps as twice yearly injections for those who can’t be effectively immunized. But that has yet to get to the EUA state.
• Other mentioned or touted drugs (hydroxychloroquine and ivermectin) have not been approved by FDA for any use in Covid-19 despite extensive promotion by some physicians and interested groups. Studies I have read in reviewed papers in the last several months did not show efficacy. We would not prescribe either one for our patients at this time for use in Covid-19 infections.

Influenza vaccinations at OHC, possibly with Pfizer booster

Everyone should get the flu shot this year. It is even more important because of the difficulty of distinguishing Covid-19 from influenza in real time. The influenza vaccines are effective and have minimal systemic side effects.

If we receive our requested Pfizer vaccine, we will offer the third shot to eligible patients (received initial 2 Pfizer doses, over 65, immunocompromised, certain specified underlying medical conditions) during the flu clinics. Vaccine vials contain six doses and have to be used within six hours, so a high-volume setting (such as our flu clinics) is needed to avoid wasting vaccine. Moreover, just-published data indicates it is safe to administer the Covid-19 and flu vaccines at the same time.

Dates and times for OHC flu clinics

Our influenza administration clinics will be in our OHC offices starting the week after next. Signup will be on our website and should be active by midweek. We will also ask you to indicate if you are eligible to and would like to get a third Pfizer vaccine at that same appointment.

Initial dates are:

Wednesday, October 13^th, 9 a.m.-2 p.m.

Monday, October 18^th, 9 a.m.-2 p.m.

Monday, October 25^th, 9 a.m.-2 p.m.

Monday, November 1^st, 9 a.m.-2 p.m.

We will hold Saturday clinics or add Wednesday clinics if we can not get all of our patients done on these dates. Additionally, we will give the influenza vaccine to everyone we see in the office during October and November. We intend to get every member immunized against influenza before Thanksgiving.

Of course, members are welcome to get their influenza immunizations at the local drugstore if that is more convenient for them. The point is to get immunized.

Outlook for this winter

The pandemic is now a long-term strain on all of us. No one alive has experienced anything like this. But by taking full advantage of the fruits of our best medical science (the Covid-19 vaccines) and continuing prudent behavior in close public spaces (masking and distancing), we can all be safe and socialize reasonably this winter. Then next spring (by which time young children should be immunized) likely will see us much closer to a normal, more sociable, and richer postpandemic life.