COVID Transmissions for 6-25-2021
Most cases and deaths in the US are now among the unvaccinated
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 585 days since the first documented human case of COVID-19. In 585, smallpox killed the Emperor of Japan. Viruses don’t really care how powerful a person is. Like I said last time, we’re lucky to have vaccines.
Today, our headlines are different variations on just how lucky, when it comes to COVID-19. We’ll discuss how unvaccinated people are dominating US numbers for hospitalization and death, how even mild cases in younger people often have severe persistent symptoms, and how the extremely rare risk of mild myocarditis from mRNA vaccines appears more than justified by the many thousands of COVID-19 cases that can be prevented.
Have a good weekend!
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Of 18,000 COVID-19 deaths in the US in May, 17,850 were in unvaccinated people
There are still about 300 COVID-19 deaths every day in the US, despite the ready availability of free and highly effective vaccination. Of course, there are still access barriers for many Americans, including lack of freedom to get time off from work to get the vaccine or to recover from its effects, but with time, I hope we can overcome these issues, because it is quite clear now that nearly every COVID-19 case can be prevented.
The Associated Press decided to take a look at the relationship between vaccination and COVID-19 in the US. That led to the numbers in the headline here, with only 150 vaccinated people in the entire country dying of COVID-19 in May. That is less than 0.1% of all deaths from COVID-19 that month. Of 853,000 COVID-19 cases leading to hospitalization in the US in May, 851,800 were in people who were not vaccinated. Only 1200 were breakthrough cases in vaccinated Americans. That is just over 0.1% of cases. This means that essentially every case going into hospitals right now can be prevented—with vaccination. In fact, since vaccination has a big impact on transmission of virus, I bet that we could probably eliminate close to all hospitalized cases if everyone got vaccinated. And we would be protecting that small population of people in whom protective vaccination is not a viable medical option.
This should really drive home the incredible power of vaccination. It should also make it clear that being unvaccinated is incredibly dangerous at this time. Carl Fink asked me in a comment if I thought this would do anything to convince anti-vaxers. I don’t, because that term applies to die-hard ideological people who do not think COVID-19 is a real threat. I am hoping that this news will convince some people, though—those who remain hesitant or skeptical of the vaccines, but who are not ideologically entrenched.
AP reporting: https://apnews.com/article/coronavirus-pandemic-health-941fcf43d9731c76c16e7354f5d5e187
Norwegian study: 52% of patients ages 16-30 had persistent COVID-19 symptoms 6 months after onset
In a Norwegian study looking to assess the risks of long-term COVID-19 impacts with mild vs severe infections, there was an interesting incidental result: a really high rate of persistent symptoms in young people:
We found that 52% (32/61) of home-isolated young adults, aged 16–30 years, had symptoms at 6 months, including loss of taste and/or smell (28%, 17/61), fatigue (21%, 13/61), dyspnea (13%, 8/61), impaired concentration (13%, 8/61) and memory problems (11%, 7/61).
Study: https://www.nature.com/articles/s41591-021-01433-3
This is really concerning. Dyspnea is shortness of breath or other trouble breathing; that’s a pretty dangerous symptom to have, and particularly uncommon in young people. As are impaired concentration and memory problems. And persistent fatigue that bears reporting in a study like this is pretty serious, too.
Often in communications about COVID-19, we focus on death rates and severe cases. I did it above, in the last piece. There’s a lot more to it than that. In the very young in particular, persistent symptoms with unknown potential dates of resolution can have tremendous impacts. We don’t entirely know how long these things will last. Will it be two years? Two decades? A lifetime? Taking risks with that potential isn’t something that I would be inclined to do, and I would take this finding as yet more evidence that it is essential to get fully vaccinated as soon as possible, no matter how old you are. With that being said, let’s talk about vaccine safety in younger people.
Myocarditis: ACIP meeting and AAP statement
We’ve been talking about the problem of vaccine-associated myocarditis for some time now, but I wanted to update on the recent American Committee on Immunization Practices (ACIP) meeting that focused on this issue. This event has been identified as being of particular concern with mRNA vaccine use in patients under 30. In that population, there were about 300 cases. Nine of those cases remain in the hospital, and as I understand it, are expected to resolve. The remainder of cases—less 5 for which data are not available—have resolved.
The risks that this represents are, frankly, minimal. The CDC director Rochelle Walensky had the following to say about it:
The American Academy of Pediatrics (AAP) also put out a statement about this, and reported on it here (contains links to other information as well): https://www.aappublications.org/news/2021/06/23/acip-covid-vaccination-myocarditis-062321
The ultimate upshot of all of this is that the FDA will be adding a warning on this extremely rare event to the labeling for mRNA vaccines against COVID-19, and they will continue to be available in younger people. This is the right call, because currently, these vaccines are the only option for protecting younger people.
As I’ve highlighted today, and as laid out in Dr. Walensky’s communications, COVID-19 is not at all a trivial risk in young people. Preventing 8,000 cases of COVID-19, if the Norwegian study results I described are any indication, could mean preventing around 4,000 cases of persistent symptoms, on top of what Dr. Walensky related. There is a lot at stake here. It is worthwhile for people in this age group to be vaccinated as soon as possible, and that isn’t even considering the broader societal benefits of vaccinating more people.
What am I doing to cope with the pandemic? This:
Garlic scape pesto, and other CSA things
The season for community-supported agriculture has begun, and we’re now getting fresh local vegetables from a farm out on Long Island every week. Early on in the season, there are a lot of leafy greens, but also something that you don’t typically find in the grocery store: garlic scapes. Garlic scapes are the plant part of the garlic, and especially when raw have a nice garlic flavor. Something I like to do with them is make a pesto sauce, using basically equal parts garlic scapes and basil leaves, plus pine nuts or walnuts for texture, olive oil for flavor and consistency, and grated Parmesan cheese. It’s not hard at all to make—adding these things to a blender or a food processor, and pulsing progressively, is all it really takes.
Last night, I made some pipe rigate pasta, added some garlic scape pesto and chunks of fresh mozzarella, and then topped it with some pan-fried zucchini and onions that I’d flavored just with salt and lemon juice, a nice counterpoint to the heavier garlic-basil flavors of the pesto. Pictured here:
I do love the farm share season.
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Always,
JS
The ACIP clearly made the right call here. Still, as I've mentioned before, I worry about what this means for vaccination of children under 12.
Young kids need to be vaccinated, too. Toddlers -- the population with which I'm most concerned because, well, I have one -- are hospitalized in roughly one in 200 cases and suffer MIS-C in perhaps one in 2,000. And they develop long COVID -- it's hard to say just how often, but also hard to regard any number as trivial. This is to say nothing of the importance of vaccinating this population to control community spread, especially with things reopening and more infectious variants becoming dominant.
Yet, I have to think that the prospect of vaccine-induced myocarditis in such young children might throw a wrench into the works when it comes to extending EUA coverage to them. This would seem to lend some urgency to determining what exactly is causing this side effect, its likelihood of occurring different populations, and whether there's a way it might be prevented (e.g., timing of doses).
Dr. Walensky also wrote that COVID-19 is a much more significant cause of myocarditis than any of the vaccines, according to current evidence. So ... to prevent myocarditis, get vaccinated!