Looking to the Future

To my Patients and Friends,

Here’s the latest COVID-19 update… I hope you find it useful.

Much ado about something

For several weeks now, the news media have been jammed with discussions about COVID-19 variants.  Just to be clear, this is a natural phenomenon. When viruses infect and reproduce in individuals prior to spreading to others, genetic mutations often arise due to errors that occur during the process of RNA replication.  In the vast majority of cases, these mutations have no major impact on the effects that a virus may have upon those who are subsequently infected.  Once in a while, however, mutations can result in the production and spread of a more dangerous virus.  Such variants of concern (VOCs) have popped up in Brazil, the U.K., South Africa, California, and New York among other locations across the globe, and they will continue to do so.  And the now well-known B.1.1.7 “U.K.” variant, which has been found to be more aggressive, has become the dominant strain here in the U.S.  Fortunately, currently available vaccines appear to be protective against this variant, although school-aged children will remain vulnerable for the near term.  Pfizer and Moderna are in the process of seeking authorization in order to get kids vaccinated ASAP.

This is why it is so important that we prevent infections through immunization and proven mitigation strategies such as distancing, use of face masks, hand hygiene, etc.  This article, using the Brazilian (P.1.) variant as an example, very nicely summarizes the mechanisms by which these mutations occur, how they can result in more aggressive viral strains, and how vaccines can help (there is some good news here: the Pfizer mRNA vaccine may be effective against the P.1. “Brazilian” variant, which now accounts for approximately 1% of infections in the U.S).  This article from JAMA discusses the level of protection we might expect from existing vaccines against newer variants; there are some concerns that the B.1.3.5. “South African” variant may be resistant to the protective antibodies that are produced in response to current vaccines.

There’s been quite a bit of discussion regarding the notion of achieving herd immunity through vaccination as a means of overcoming the COVID pandemic.  Unfortunately, it appears increasingly likely that, because of vaccine hesitancy (this article illustrates the kind of madness we’re up against) and shortfalls in vaccine distribution to at-risk regions around the world, variants will inevitably continue to emerge.  This means that we may be facing a much more protracted pandemic, such that it will be necessary for us to receive periodic booster vaccines in order to remain protected.  But rest assured that this process is already in the works.  And we will need to ensure that current testing methods remain capable of detecting newer strains, particularly as “breakthrough infections” after having been vaccinated are still possible.

Should I receive a vaccine if I’m pregnant?

The CDC has advised that, based on the most current evidence, vaccines are safe for moms-to-be and their unborn babies.  Of course, this conversation should take place between expectant mothers and their physicians.

What if I’ve already had COVID?

I would encourage all of the COVID veterans out there to resist the temptation to throw all caution to the wind.  It’s not a foolproof scenario… those who have previously had COVID may still face some residual risk for reinfection.  However, it does appear that only a single dose of an mRNA vaccine (i.e., Pfizer or Moderna) is necessary in order to provide optimal protection after having had COVID illness.

And for the rest of us?

Optimal protection can generally be expected only after having been fully vaccinated (for mRNA vaccine recipients, this means two doses).  Unfortunately, more American are opting out of their second doses– another major obstacle to herd immunity.

J&J is back

The 11-day pause on the Johnson & Johnson vaccine has been lifted.  Health officials have determined that the benefits of receiving this vaccine far outweigh the risks.  That said, many Americans will likely opt for other vaccines.

In the end, optimism

Dr. Anthony Fauci feels confident that a turning point is near.  A new normal may be just around the bend… let’s hang in there!

That’s all for now… be safe and don’t be afraid of vaccines!  I hope you all enjoy the upcoming warm weather