The COVID-19 Vaccine Is Becoming More Available. Exercise Patience.

COVID-19 vaccine preparations are arriving in South Florida with several hospital systems opening appointments for men and women 65 and older to receive their first injection. Some will receive the Pfizer product, others the Moderna product. If you wish to travel to Dade County go to https://jacksonhealth.org/keeping-you-safe/  and sign up for the vaccine. They are taking appointments.  West Boca Medical Center and Boca Regional Hospital have opened appointments for non-employed medical staff members and their office staffs to receive vaccine with the hint that the week of January 11, 2021 they will start vaccinating community members.  

There is a sense of urgency and panic in the community about not having access to the vaccines. That is unnecessary and raising the stress level inappropriately.

After you receive your first vaccine dose you will still need to avoid crowds, social distance, wear masks and practice impeccable hand washing hygiene because you will not be immune. Twenty-one to 28 days later you will receive your booster shot and it will take about two weeks before we can detect antibodies to COVID-19 if you develop immunity.  You will have peace of mind, but won’t know if the vaccine prevents individuals from catching COVID-19 when exposed completely?  Will they get COVID-19  and have a very mild case because of the vaccine prevention?  Will these people be contagious to others? We do not know the answers to these questions yet.

If you get the vaccine, develop immunity and are exposed to someone with COVID-19, will you possibly transmit the virus to others without you yourself becoming ill?  No one knows the answer to that question yet either.  If everything goes perfectly well, and you develop a protective shield of immunity like a comic book superhero shield or cape, how long will that last?  Nobody knows that answer either.

The point is the vaccine is coming.  Once vaccinated we will still have to behave the same as before until the answers to these questions are known!  Please be patient.

A Perfect Storm Brewing: Flu Season Plus A COVID-19 Resurgence

I was asked by a colleague what I thought influenza seasonal infections coupled with a predicted second wave of COVID-19 would look like locally? Influenza A arrives locally around Thanksgiving and peaks the last two weeks in January and first two weeks in February. I suspect it is fueled by seasonal visitors coming to Florida bringing the disease from their home locales. We see a low level of influenza B year- round in our pediatric population.

A full-page ad appeared in all Florida newspapers today sponsored by every major health system in the state including Baptist, Tenet, HCA, Cleveland Clinic, Broward Health, Jackson, U M Health, Memorial Health and others. It stressed wearing masks, social distancing and frequent hand washing.

If you get sick with mild symptoms, they encourage remote telehealth care. If you have moderate symptoms, they suggest going to their urgent care facilities. For severe symptoms call 911 or go to the ER. At no time did they suggest calling one of their employed physician offices or visiting your private doctor which is all consistent with CDC recommendations. Private independent and employed physicians just don’t have the ventilation systems, sanitizing systems, personal protective equipment or trained staff to see potential COVID patients in their offices. If a patient is positive, or a staff member converts, what is their responsibility to the next patient or to the other tenants of their building? Is a 14-day quarantine in order?

Much depends on unknown factors. How effective will this year’s flu shot be? In my area, the chain pharmacies already received their supply of influenza vaccine and have shamelessly been pushing it on customers since July. Scientific research shows that in senior citizens the flu shot immunity begins to subside 90 days after you receive the shot. Given that, if your pharmacy tech gives you the flu shot in September, then how much immunity will you have by the time the flu arrives around Thanksgiving?

Quick, accurate and inexpensive testing availability for flu and COVID 19 is an important factor as well. We have had a quick influenza test for years requiring a nasopharyngeal swab. A similar test for COVID -19 has just been released by Abbott Labs and received Emergency Utilization Authorization from the FDA. That means Abbot Labs researchers say it works and the FDA takes them at their word. This test, called “a game changer” by many, will be available in October.

When $15 per hour medical assistants start performing the test rapidly, in volume, I hope the accuracy results are similar to Abbots claims. Our health and lives depend on that. At the same time a finger stick blood drop test is heading to market to quickly detect flu and COVID -19 on the same test card. Finnish scientists and Israeli researchers have quick breathalyzer tests coming soon as well. I hope they work and get here soon. I will test everyone at the door as will restaurants, theaters, sports arenas and most businesses.

All of this information really skirts the issue. With no treatment and vaccines available yet, I expect this flu COVID-19 season to be a human health disaster. With no national plan in place and no close coordination with state and local elected and public health officials, I see the fall and winter as a time of continued disease surges and deaths while the political influence on disease treatment supersedes scientific research and public health realities. Without a coordinated program of PPE and medication distribution, coordination of testing availability and results with contact tracing and specific shutdowns of hot spots without challenges related to loss of freedoms the outlook is grim.

Protecting senior facilities without a coordinated program and funding for it will not work for residents or employees. Opening schools and day care without similar precautions, training and funding for materials and tracing will lead to hotspots as well. There are members of the student population such as special needs children who need to return too, in person, learning safely and creatively. Others need to learn remotely or be given a chance to catch up later when safe return to in person learning is possible.

Without a plan to assist renters, homeowners, landlords, small business owners, farmers, restaurateurs, etc.; any shutdown for disease will be met with overwhelming resistance. I see a bleak and dangerous health picture developing in the fall/winter creating a perfect influenza/COVID storm.  I hope I am wrong but, if right, the disease surge will overwhelm ERs and hospitals.

Dogs, Cats and Coronavirus

There has been conflicting information on whether our pets can contract and pass on COVID-19 to other pets and humans. Initially, a report out of Wuhan, China noted that a dog tested positive for COVID-19 infection. Additional evaluation of that animal proved the test result was a false positive and the animal was neither ill nor contagious.

Several articles have appeared in newspapers and on TV news shows encouraging individuals to cuddle with their pets for anxiety and stress reduction. Then came the report out of New York City that one of the big cats at the Central Park Zoo tested positive for Coronavirus and was ill. Shortly thereafter, several more of the big cats tested positive.

This week an article was published in the peer reviewed journal called Science. Zhigao Bu, PhD, of Harbin University Veterinary Research Institute of the Chinese Academy of Agricultural Sciences in Harbin , China looked at whether animals could pass the virus through respiratory transmission. The purpose of the study was not initially to determine whether the virus could travel from pets to humans. The real purpose was to find an animal model that they could test new vaccines against COVID-19 on and test medication regimens.

They first looked at ferrets and found that while the virus could replicate in the upper respiratory tract of the animals for three to eight days, it did not make them sick and they were not contagious. They next turned to young cats. They inoculated their nasal passages with the virus and placed these infected kittens next to healthy kittens. They found that the virus was transmitted to the healthy non-inoculated cat with the animals developing the respiratory disease. Necrotic lesions were found in the respiratory tract of these test animals and they were found to transmit the virus by an airborne route.

They next tried the experiment on young beagles. While the virus was detected in the blood of the dogs inoculated with the virus, none of the healthy dogs exposed to them contracted the virus. The inoculated dogs developed antibodies against the disease but none of the beagles became ill. The dogs were felt to be non-contagious. Similar experiments showed that pigs, chickens and ducks did not contract the virus nor were they contagious to their species or humans when inoculated with the virus.

From their research it is probably true that dogs will not contract the disease and transmit it to other dogs or humans. It appears that felines however are susceptible to COVID-19 and may be a reservoir for the disease or a vector of transmission.

Passover and the COVID-19 Pandemic

Passover has never been one of my favorite holidays. As a child with nuclear families still within walking distance the work of changing dishes and silver ware, disposing of the chametz and cooking for 15 or more people made the event not very likeable. The seder’s were long while being conducted in a foreign language (Hebrew).  Even the attraction of having thick sweet red wine as a minor and getting a cash reward for finding the hidden matzo, were not enough to overcome the long tiring nature of the meal and storytelling.

It’s now 2020 and the world is suffering through a plague of its own. The numbers of sick and dying are simply numbing and force you to slow down and remember that each statistic represents a human being. This is someone’s loved one.

With that said my family is following the guidelines of staying home and social distancing. That will mean my grandson, who lives 60 minutes away with my daughter and wonderful son in law, will be having their holiday dinner in their home. They have been distancing for over three weeks now with no trips into the community except to walk the dog and to see her obstetrician.

My daughter lives in the zip code with the most cases in South Florida and she comments constantly that her young affluent neighbors fail to obey most of the restrictions and guidelines announced by the Governor and the Florida Department of Public Health and the CDC. Her sisters in Venice, California and Berkeley Heights, New Jersey will do the same. They are social distancing, staying home sharing their seders’ via Zoom. They will have company with their cousins in Boston, one working in a hospital with the Harvard School of Public Health and Washington, DC at Washington’s Children’s’ Hospital. Their parents from Naperville, Illinois will be in on the computer seder as well. We have no idea how this will turn out but, unlike usual years where I lead the seder service or split it with Uncle Alan, this one will involve assigned roles per Aunt Meryl.

The traditional food will be different as well. The days of me coming home from school and running to my maternal grandmothers’ apartment to see the white fish swimming in her bathtub prior to her making her own gefilte fish are long gone. In recent years, it has been finding the correct Jewish deli that makes its own fresh gefilte fish and chopped liver but even that is on hold due to the coronavirus outbreak.

If there is fish it will come from a jar. Without the chicken to make chicken soup our matzo ball soup will come from a can as well. The matzo will be real. The concord grape Manischewitz wine will be real. The Passover Farfel or a potato nick will be real and there are no dry Passover dessert cakes or macaroons. This year my daughter’ s birthday fell prior to the holiday so we are all spared her complaints that the holiday prevented her from having a “real” birthday cake.

This is not the year for community or restaurant or country club seders. This is the year to stay home, be thankful for your loved one’s health and look forward to better healthier times.