Miller Report for the Week of November 16th, 2020
By William Miller, MD – Chief of Staff at Adventist Health – Mendocino Coast Hospital
As the news media reports a surge of new COVID cases, there is also optimism as two vaccines for COVID have just been approved. At a time like this, I think it is important to try to keep things in perspective and make some important and level minded decisions.
First, the numbers of new cases being diagnosed in California are over 10,000 per day and across the US over 150,000 per day. This is a rate that is almost triple that of just a month ago. Fortunately, the vast majority (80%) of those people will not get particularly symptomatic if at all, but about 20% or 30,000 per day will. Of those 30,000 per day, about one-third may require hospitalization. That is a big number and is already putting a strain on the health care system in many parts of our country.
While those numbers are certainly high and a valid cause for concern, it should not be a big surprise either. We have known since the beginning that the winter months would bring a significant upswing in cases and we have been preparing for this eventuality. What it does tell us is that we should all plan on spending the holidays at home this year. It is not a good idea to have large numbers of people traveling back and forth across the country right now as that is just going to literally stir the pot; leading to a greater spread of the disease. This includes both traveling away to visit family and having them come here. I hear folks talk about how they will “be really careful”. Well, the most careful thing you can do right now is stay put. As hard as it is for us to accept, this holiday we should all make our visits with our loved ones virtually.
On the vaccine front, the FDA approved a Pfizer Pharmaceutical vaccine for COVID last week and one by the pharmaceutical company Moderna this week. This is very exciting news. I have historically been skeptical about how effective such a vaccine would be based on early studies with traditional vaccines for coronaviruses. However, these use new technology that involves the injection of a fragment of genetic material, called messenger RNA (mRNA), that induces a person’s cells to manufacture a surface protein from the virus. This mRNA degrades in the body very quickly and is not incorporated in any way into the person’s body. There is no worry that a person’s own genetic DNA would be altered in anyway.
This viral surface protein then stimulates antibody production. These antibodies are very similar to the antibodies in convalescent serum that has been found to neutralize the virus. The shot requires a booster to be given in about 3 weeks. Immunity occurs in over 90% of people vaccinated and appears to last 4 months, perhaps longer.
As production ramps up, the initial supply will be given to health care workers and other front-line personnel and will be preferentially directed towards areas of the country seeing the greatest numbers of cases. Reports are that vaccination of health care workers could begin as early as end of December. If our experience with other COVID related responses is a gauge, then I am guessing we will be slow to get the vaccine here, perhaps early February for health care providers and May or June for the general population on the Coast. However, that is just a guess.