COVID Forum Follow Up Information

The below are responses and website references from Dr. Ramers from our Adult Forum on COVID last Sunday (March 28, 2021 at 9am). You can view the original recording on our YouTube channel (Click Here).

County DashboardCompare one year ago with current information (like in your most recent FHCSD webinar) – I’d say overall, we are much better able to manage COVID-19 cases (early treatment with monoclonal antibodies is highly effective, hospital and ICU protocols are better), and most vulnerable populations have high vaccination rates, so we’re less likely to see hospitalization and death.  Having said that, we’re still at case rates that are equal to our ‘summer surge’, so not out of the woods yet.  Provide the County Dashboard website so people can look up information themselves www.coronavirus-sd.com https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—23-march-2021  (need to google ‘WHO weekly epidemiological update’ to find the latest version)https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html  https://covid19.ca.gov
MasksAre masks really effective against COVID? YES! There is no doubt about it.  CDC has good resources here: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html What are the best masks to wear? How to properly wear two masks https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html
COVID-19 and VaccinesCan we believe the vaccines are safe? What if I want to wait to see how safe they are? https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-02/28-03-01/05-covid-Shimabukuro.pdf I’m in good health and not old and sick. Should I be worried about COVID? YES, for two reasons: 1) you may still transmit unknowingly to an unvaccinated vulnerable person and kill them, and 2) no matter how healthy you are, you may have long-term problems from ‘Long-COVID/PASC’. information here about long-COVID or PASC: https://directorsblog.nih.gov/2021/01/19/trying-to-make-sense-of-long-covid-syndrome/ www.survivorcorps.com What variants should we be most concerned about?  https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.htmlWhen will children under the age of 16 be vaccinated? Clinical trials are fully enrolled for Moderna and Pfizer for age 12-18, starting soon for J&J.  I would expect results and approval within 2-3 monthsWhat are the long-term side effects of any of the FDA approved vaccines?  The vast majority of side effects from vaccines will show up within 2 months, hence the FDA decision to require at least an average of 2 months of follow-up before manufacturers can request EUA.  The only real concern beyond 2 months is something called ‘vaccine-induced disease enhancement’ where the vaccine makes the disease worse if/when the person is exposed. COVID-19 vaccines have been carefully designed to avoid this type of immune response (has to do with directing TH-1 vs. TH-2 immune responses) and there has been absolutely not sign of this in early trials, so the risk is extremely low. How effective are any of the vaccines against the variants?  Slight decrement in response in the following order: B.1.1.7 (UK) = minimal decrease < P.1 (Brazil) < modest decrease <<< B.1.351 (South Africa) significant decrease.  Best data is from J&J which seems to still protect quite well against even the South Africa variant.  Worst data is from AstraZeneca which looked minimally effective against B.1.351.  Moderna and Pfizer were somewhere in between. Is the AstraZenica vaccine associated with higher risk of blood clots? Possibly a very small risk (on the order of 5 per million), but currently risks of COVID-19 far outweigh risks of the vaccine. Will we need a booster shot? If so, when? Hard to answer this as it will depend entirely on how fast variants spread and how fast we can get our population vaccinated.  Moderna, Pfizer and J&J are all currently testing new versions of vaccine directed at variants, and FDA has laid out a clear pathway to approval of modified vaccines that will NOT require large clinical trials, so if we need them, they should be ready by the fall. https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html https://outbreak.info/location-reports?loc=USA_US-CA_06073&selected=S%3AE484K&selected=B.1.1.7&selected=B.1.351&selected=P.1 https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html
TravelIs it safe to travel if people have had 2 vaccine doses (or 1 dose of J&J)? I would caution against ‘risk absolutism’ since it’s not practical to restrict all human activity unless it conveys zero risk…having said that, it would be much safer to wait 14 days after the last dose when strong protection is likely.  What are good guidelines if you have a 3-hour or longer flight? Would advise getting the best mask you can (N95, KN90, or surgical + cloth), ensuring it fits your face well, using eye protection (clear goggles or face shield), not eating or drinking on the flight, keeping hands and surfaces sanitized with alcohol, and being careful around large crowds in the arrival and departure airports as well. Is it safe to travel abroad if I have had 2 vaccine doses? I would not feel safe traveling to Africa, South America, or Europe at this point as cases in many places are much worse than in US right now.  Also, would need to check each country’s travel restrictions—some may require Quarantine, test, or vaccine.
Cathedral WorshipWhat are the challenges and risks of in-person gatherings inside the Cathedral? Do we need to be that cautious? In-person gatherings of larger groups of people are unfortunately relatively high-risk events, and there have been many ‘super-spreader’ events tied to congregate gatherings.  Outdoor functions are thought to be about 20X less risky for transmission, and as vaccination rates increase, transmission becomes less and less likely. If congregation members are vaccinated, why are there limitations on indoor and outdoor gatherings? Firstly, vaccines are not 100% effective particularly for those with immunosuppressive conditions.  After vaccination, asymptomatic spread is still possible.  As for larger gatherings, it’s a matter of math, the more people present, the higher likelihood of spread from an asymptomatic or symptomatic person.  I think public health authorities will likely allow larger in-person gatherings as the very last thing and only when community transmission is very low. When will we be able to return to church services without limitations on the number of people? When community transmission is minimal and >75% of the population is vaccinated. When will we be able to sing in church again? Likely not for a while at least without masks.  This cautionary tale from a choir practice in Washington that became a super-spreader event demonstrates how dangerous the simple act of singing together can be—caveat that this was before universal masking and vaccination: https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm All of these are difficult questions as indoor group gatherings, particularly with *any* unvaccinated individuals, and with singing or chanting have been repeatedly shown to be higher risk for transmission.  Given legal sensitivities and involvement of judicial systems in high profile cases, best to stick to state guidance. https://covid19.ca.gov/industry-guidance/#worship
Schools Openings  My younger grandchildren do not want to go back to in person learning, but they are in need of socialization. They need to be with peers in person. How long do you think it will take to get the students socially up to their age level after one year plus of being confined to home?My high school grandson does not want to go back to class in person. He said he does not trust the other students or the school to adhere to the CDC rules for returning to in person learning. You do not know the students or what the school will do at the time of opening so this may be unfair. His concern is that masks will not be worn all the time and there will be congregating of students in an unsafe way. None of them will be vaccinated at the time the school is scheduled to open. Do you think his concerns are valid?My response is that it is impossible to know the behavior of your child or grandson’s friends, so he/she should be trained to be ‘universally cautious’ with the precautions that we know will work.  Universal masking, some degree of testing availability, high vaccination rates for all who are eligible (currently age 16 and up) and minimizing broader community transmission are the foundations of safe school re-opening plans. I would encourage educating the students in your family and holding schools accountable to enforce sound policies.  The School reopening debate is a very charged issue, but Pediatricians and Educators I think are very much aware of the immense social, emotional, nutritional, equity and educational harms that go along with not having in-person instruction.  The two aspects that still give me pause are 1) the potential for unvaccinated children to serve as vectors to transmit virus to more vulnerable relatives who have refused or not been able to be vaccinated and 2) the ‘not entirely benign’ manifestations of COVID-19 in children, which include a rare inflammatory condition called MIS-C as well as the potentially devastating consequences of long-COVID/PASC on student-athletes.  https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html

Thank you Dr. Christian Ramers for this information!

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