Cut and paste:
Delta variant.
Clearly much more contagious than prior variants, similar to chickenpox level. However it seems to be no less deadly then prior Covid variants. As the weather changes it will come north in higher numbers. Get protected and get vaccinated.
Vaccines.
All still incredibly protective against hospitalization and death. Protection against illness wanes with time but still provides good protection even after months. 90+% of Hospitalizations, ICU admits, deaths and patients on ventilators are unvaccinated. This is being seen in hundreds of hospitals with thousands of patients.
Vaccine side effects.
All the vaccines remain extremely safe. The vast majority of reactions are simple allergies that respond to Benadryl. There are a few rare cases on myocarditis (heart inflammation) in younger people getting the Moderna and Pfizer. The vast majority of those resolve within a day or 2 with Motrin. Among J&J recipients there are a handful of cases of blood clots with low platelets. Almost all of the cases were among adult women under the age of 50.
“I heard someone had xxxx after getting the vaccine. Isn’t that a side effect and why aren’t they reporting it.” We have never given a vaccine or any medication to hundreds of millions of people in a few months. Every regular health problem looks like it is related to the vaccine. That is why the CDC is monitoring for rare side effects that exceed the baseline rate in the US. Indeed we have successfully picked up a couple one in a million effects so you can rest easy that the system is working.
Long Term effects.
How about long term side effect? No vaccine has ever been shown to have a long term side effect that wasn’t picked up in the first few million doses. We have administered 364 million doses in the US. Worldwide Billions of doses have been administered. The first vaccine doses were administered in trials in March 2020. Full phase 3 trials started July 2020. So we are more than a year out and millions of doses in. Locally we have administered more than 100,000 doses of vaccine and have seen no side effect that could not be treated with Motrin or Benadryl.
Boosters.
A 3rd shot for Pfizer/Biontech and Moderna (and AstraZeneca) have been shown to boost antibody levels way up. Early data show the same for J & J. Clearly for high risk patients a booster is warranted. There is no data on mixing boosters from different vaccines but theoretically there should not be a significant difference.
Although Pfizer/Biontech and Moderna have a delta specific booster in the lab they have both stated that they do not need to change to that formula and the regular shot protects against delta well, especially with a booster. That may change in the future (or not)
Children.
Children still seem extremely unlikely to develop severe Covid19. Pediatric cases are definitely way up as cases rise but they are very likely to experience a mild case. As they remain the least vaccinated group they are most at risk for Covid while generally not winding up in hospitals or ICUs. Children get hospitalized 0.9% of the time and die in 0.01% of cases. Those numbers have not changed in months.
Vaccines for younger kids are coming. The data is submitted but the FDA seems to be focused on full approval and booster recommendations rather than assessing the pediatric data. A bit frustrating that they can’t do both at the same time.
Therapeutics.
Dexamethasone (a steroid) has been a game changer for severe hospitalized Covid patients and greatly reduced mortality in the most ill.
Remdisavir, an antiviral, has some effect too.
Oxygenation. Knowledge learned from experience with oxygenation and ventilation has also made a big difference.
Monoclonal antibodies from Regeneron and others have been shown to reduce the chance of hospitalization and death if given early (first few days) in the course of the disease. Do not wait. You should receive it if you are high risk (criteria recently expanded) even if you feel “fine.” If you are vaccinated and high risk yet get a breakthrough case I would still consider getting the antibody treatment. Talk to your doctor and remember if you are getting it time is important. Don’t “wait until I feel bad, or wait until Monday.”
Hydrochloroquine, Vitamins, Zinc etc. No benefits shown despite extensive research. Often we see things in the lab that don’t work in real life. For example people with low Vit D have been shown to have worse Covid outcomes. But every study testing vitamin D supplementation failed to show a Covid benefit. How can that be? Well is you consider that those with higher Vit D levels might be outdoors more and generally in better health they naturally would be less prone to severe Covid. So a healthy lifestyle both boosts vit D and protects against severe Covid. However other than the cost there is little downside to taking a multivitamin daily.
Pepcid (famotidine) small studies showing potential benefit but larger studies have not backed up the benefit. A large study from Northwell should be finished and data reported soon. Pepcid is a relatively benign drug that has been around a long time so low risk to take it. However I would have expected more positive studies if Pepcid was helpful vs Covid. So I have my doubts.
Fluvoxamine (Luvox), an SSRI similar to Prozac, Has been shown in preliminary studies to reduce the need for hospitalization. The mechanism is thought to be that Fluvoxamine blocks some of the runaway inflammation pathways that make covid severe. Confirmatory studies are forthcoming. Definitely something to keep an eye on.
Ivermectin. Small poorly done studies from 3rd world countries have show benefit vs Covid. Other studies do not show benefit. Although its been around a long time most physician have no experience dosing or watching for side effects. In addition this drug has potential severe side effects. I would not take or recommend Ivermectin for anyone except if enrolled in a well designed study.
Coming antivirals. A few companies are testing antiviral medications now. Hopefully they will be available soon and in pill form. Traditionally antiviral (as opposed to antibiotic) medications are not super powerful and often only work in the first few days of illness or as a prophylaxis.
Hope that answers some questions
Michael Ameres, MD