8-17-21

Dear Minister and Faith Leaders,

 

The fourth wave is unfortunately going strong. We had decreased from 30 COVID patients to 21 last week and felt hopeful – however we again hit 30 again this weekend and ran out of ventilators Monday. We received 5 extra ventilators from the state warehouse that same day to help support our need. Community numbers of active tested individuals is up as well, reported as over 300.  We have 8 ICU nurses approved from the state to come help care for patients during this surge.  

 

In terms of visitation, non-COVID patients may have 2 visitors at a time, and COVID patients do not have visitors, except for changes in status, for 10 minutes per day in full PPE.  Today, 2 of the patients with COVID in the hospital were fully vaccinated with Moderna and both are over 80 years old. Two had one shot of Moderna. The other 28 were unvaccinated.   

 

I think as more and more of the vaccine hesitant see people that they know get severely ill with COVID, more are willing to accept the only real preventive treatment for severe COVID illness. We had a great talk on this from Dr. Creech at Vanderbilt, who is an expert in vaccine development, immunology, and is on vaccine safety boards for the FDA. I will not be able to present his information as well as he did, but wanted to share some of his points:

 

-the delta variant is more infectious than alpha – one person infected 3 other people with the original strain, now one infects 7.  For chickenpox, one person infects 10, for the 1918 flu one infected 2, and for measles one infects 18. 

 

-the delta variant is still well covered by the vaccines available.

 

-breakthrough infections are possible, but still extremely low compared to the unvaccinated population.

 

-at infection, the viral load of the vaccinated is just as high as the unvaccinated.  However, the vaccinated patients clear the virus much more quickly, and so are infectious a shorter period of time. (This is why vaccinated people should still wear masks inside around others.)

 

-vaccinated individuals can still be infected with COVID, but there is an 8 fold reduction of infection, a 25 fold reduction in hospitalization, and a 25 fold reduction in death. 

 

-the overwhelming majority of cases and hospitalizations now are among the unvaccinated, the immunocompromised, and children.

 

-there is no other treatment for COVID infection that is available that has shown much benefit.  Therapies such as ivermectin and vitamin supplements are not recommended at this time. 

 

He noted that as part of the FDA studies, they take pregnant animals and give them super high doses of vaccines to try to create problems, and there were no pregnancy or fertility issues in those studies (DART testing).  In the many pregnant women and women who got pregnant after vaccination, there have been no safety problems with the vaccine.

 

In terms of if people who had COVID need to be vaccinated, he and his family had COVID, and he works in a lab that measures antibody levels. His teen with mild symptoms had antibody levels around 8,000 (over 4000 good), his wife with 4-5 days of more severe symptoms had levels in 20,000s, and he had pneumonia and was very ill several weeks and his antibody levels were 100,000s. He got the vaccine and his antibody levels 2 weeks after his vaccination was 1,200,000. He felt that vaccination after even a severe COVID illness was meaningful protection against further COVID infection.

 

We still don’t know duration of immunity or if we should mix vaccine types. He thought that boosters for health care workers would be recommended by FDA mid-September. 

 

He noted that most of the children getting hospitalized have chronic underlying conditions (such as asthma). Current testing for vaccine safety is now occurring to the age of 6 month old children, and he suspected 7 -12 year old vaccination would be approved December or January. 

 

He did note that Emory has done a study where antibody levels and B and T memory cell behavior in patients with a COVID infection and one dose of vaccine were the same as an uninfected person who had 2 doses of vaccine. 

 

The Emergency Use Authorization converting to regular approval status for the COVID vaccination is just waiting on the massive paperwork and plant inspections. The only change in activity for when the vaccines have the routine (not emergency) authorization is that it would allow the companies to advertise on TV, and compensation and liability models change for the vaccine company. He noted that vaccine study data really is most meaningful in what happens the first 3 months after vaccination. He noted allergic reactions are going to occur the first week after vaccination, and any weird auto immune issues (Bell’s palsy, Guillain Barre) would declare themselves in the following few weeks. He noted that any side effect to the COVID vaccines were more rare than being hit by lightning, including myocarditis and clotting issues from Johnson and Johnson. He noted that extreme vigilance in monitoring those who had been vaccinated were the only reason those case studies were noted. 

 

He estimated based on England and mid-Western delta infection behavior, that the South has about 3-4 weeks more of illness before we plateau. It was interesting that Iceland has some of the best vaccination rates, and they are still seeing delta in their population, but with rare ICU admissions, giving further evidence that even though a person could get COVID after vaccination, that there is a very low chance of severe disease.

 

The Health District will be giving booster COVID vaccinations at the COVID Clinic 1128 Clarksville to people that state they are immunocompromised, and will not be taking a health history as to the cause of immunocompromise.  The FDA recommendation is for people on steroids, on immunosuppressants for transplanted organs or other underlying causes, or active chemotherapy to receive a booster if they are 28 days out from their last vaccine. 

 

I tried to look up the 9 Texas monoclonal antibody infusion sites. There is one in San Antonio, Harlingen, Corpus Christi, Lubbock, Austin, Laredo, and Dallas. Fort Worth and Irving were sites in January, so those may round out the 9. There is not a local site for monoclonal antibody infusion at this time.

 

Numerous leading medical organizations cosigned a statement urging all pregnant individuals, along with those who are recently pregnant, planning to become pregnant, or lactating to be vaccinated against COVID. A study published by JAMA Network Open on Aug 11 reported the effects of COVID during childbirth, comparing 18,715 women who gave birth with COVID to 850,364 without COVID and found higher rates of preterm birth (16.4% vs 11.5%) and hospital mortality (0.1% vs <0.01%) associated with COVID infection. 

 

The safety and effectiveness of the COVID-19 vaccine have been reported in several randomized controlled trials. One of the earliest was in the New England Journal of Medicine.  https://www.nejm.org/doi/10.1056/NEJMoa2035389

 I have attached a good graphic of the long term effects of patients infected with the COVID virus.

 

As school starts, quarantines will still be required for unmasked indoor interactions with COVID positive individuals unless vaccinated. The Texas DSHS has confirmed that the TEA recommendations to school in no way changes the health rules already in place for the reduction of spread of infection in the pandemic.  I am sad that if a masked child interacts with an unmasked positive child, that they will still have to quarantine if unvaccinated, even though they tried to do all that was within their control.  I am proud of Clarksville ISD and Paris ISD for putting the health of their students first during this surge of infections, and requiring masks until a reassessment of community infection levels September 3.  

 

Trusted medical literature sources show that vaccinations are working, and masks at least don’t hurt, and probably help reduce spread of airborne and droplet diseases. Thank you for sharing with your friends and congregations as we try to keep people healthy and safe. 

 

 

Thank you for all you do! Stay well!

 

Amanda 

 

 

Amanda Green, MD, FACP, HMDC

Chief Medical Officer, Paris Regional Medical Center

Paris Lamar County Health District Medical Director

Lamar County Health Authority

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