CMG COVID-19 Weekly Update 6.13.21
New or Updated This Week:
CMG Covid Updates to Decrease in Frequency (new)
More Worrisome Data From the UK on the Delta Variant (new)
Monitoring Cases of Myocarditis and Pericarditis After mRNA Vaccines (updated)
The Return of Non-Covid Illnesses (new)
Status of the Pandemic in the United States and the World (updated)
Status of the Pandemic in the Washington Area (updated)
Statistics – CMG Tests for Active Disease (updated)

Hello again everyone. This is the 66th in a series of COVID-19 updates from Capitol Medical Group. These notices are meant to provide an update on the pandemic, explain procedures we have put in place to best serve you, and provide guidance about protecting yourselves and your families. New and updated sections are so indicated.

In an effort to ensure that this notice reaches everyone in our practice, we are sending it to every patient on file rather than one per family. Our apologies if your family receives multiple copies.

CMG Covid Updates to Decrease in Frequency (new)

Today’s update will be the last to occur on a weekly cadence, at least for the time being. We are gratified that so many of you have found these updates useful and are extremely appreciative of your efforts to remain safe during the pandemic.

We are at a point in the pandemic where many of the significant questions regarding Covid-19 have been answered. The virus is spread by inhalation of viral particles exhaled by others. Viral transmission is much more likely to occur indoors than out. Masking is extremely effective at decreasing the likelihood of transmission, including in indoor settings such as schools. Children are far less likely to be severely affected by the virus than are adults. The vaccines in use in the United States are extremely effective, even against the most problematic variants identified to this point. Full vaccination makes hospitalization and death an exceptionally unlikely outcome for those with fully functioning immune systems. The vaccine program has reduced the case rate, number of people hospitalized, and number of people dying per day in the United States to the lowest levels since the early days of the pandemic. Vaccines are freely available, including at CMG.

Though these issues have been settled and viral transmission in the United States is at a relative ebb, the pandemic is by no means over. Those who do not have immunity are still at risk should they encounter the virus. There are still many issues to follow and areas of concern. Foremost at the moment is the likelihood that the Delta variant will become predominant in the United States and cause another wave of cases among the unvaccinated. We are also monitoring the data regarding cases of myocarditis in young people after receiving the mRNA vaccines.

There will be other issues as time goes on, but we feel the pace of major scientific developments has slowed to the point that updates are not needed as frequently. If the pandemic worsens significantly, we may return to a regular cadence for this newsletter at some point. For the time being, however, it will become occasional. We will notify you when major events occur, when our office procedures change significantly, and will update you periodically on the status of the Moderna vaccine study at CMG. Thank you so much for devoting your attention to the science all this time.

More Worrisome Data From the UK on the Delta Variant (updated)

Though the total number of cases in the UK is still small relative to the winter peak, cases there are currently increasing at an exponential rate and covid-related hospitalizations have also begun to rise substantially. The trajectory of new cases and hospitalizations over the last few weeks is similar to the initial phase of the fall/winter wave. In some parts of England cases have been doubling every 4.5 days. Over 90% of cases in the UK are now attributable to the Delta variant, which has supplanted the Alpha (B.1.1.7) variant with remarkable speed. According to Public Health England, Delta is associated with a 60% increased risk of household transmission as compared to Alpha, which was previously considered to be the most contagious variant. The increase in cases and hospitalizations resulted in a decision Friday to delay the long-planned full reopening in the UK for at least a month.

This type of surge was not thought to be likely in the UK, one of the world’s leaders in vaccination. Roughly 43% of the population is fully vaccinated in the UK, similar to the United States. Another 17% are partially vaccinated. Those who are fully vaccinated appear to be very well protected against Delta, but it is spreading rapidly among the unvaccinated and to a lesser extent among the partially vaccinated. Public Health England’s most recent Technical Briefing, focusing primarily on Delta, can be found here.

Though the rise in infections and hospitalizations is similar in trajectory to the beginning of the UK’s second wave, it is not likely to become as extensive or as lethal. Because a significant percentage of the population has immune protection through vaccination or prior infection, the total number of susceptible individuals is far lower than during the fall/winter wave. This should keep the total number of infections lower than it would have been otherwise. And because those who are unvaccinated and therefore susceptible tend to be young, we expect the coming wave to result in a smaller number of deaths.

We suspect the United States will eventually see the beginning of another surge similar to what the UK is experiencing now. Delta reached 6% of sequenced cases in the United States this week. As that number climbs, we expect to see an overall increase in caseload in the US in the coming weeks or months. Pockets of the United States with particularly low rates of vaccination are likely to see more significant increases as Delta takes hold. We strongly encourage those who have not yet done so to pursue vaccination at this time, before Delta becomes more prevalent.

Monitoring Cases of Myocarditis and Pericarditis After mRNA Vaccines (updated)

The CDC continues to investigate reports of myocarditis and pericarditis following administration of the mRNA vaccines. It is still not clear whether there is a causal link between the vaccines and these cases. According to a presentation by the CDC’s Vaccine Safety Team Thursday at a meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee, trends in these cases appear to be as previously reported: more likely in males than females, more likely in teens and young adults than older adults, more likely after dose 2 than dose 1, and most often mild in severity. It appears that the number of observed cases after dose 2 exceeds the expected background rate in the 16-24 year old age group.

The CDC continues to recommend that all patients 12 and over get vaccinated while investigation of this issue continues. This is because the risks associated with contracting Covid-19, including for adolescents and young adults, are vastly greater than the potential risk of vaccine-associated myocarditis. We agree with this view, and continue to recommend vaccination for everyone age 12 and over. If you or your child develops chest pain in the days after receiving the vaccine, please let us know immediately.

The Return of Non-Covid Illnesses (new)

The CDC issued a health advisory this week documenting a recent increase in cases of Respiratory Syncytial Virus (RSV) in parts of the southern United States. RSV is a respiratory virus that typically circulates in the fall and winter. It is relatively unusual for it to become prevalent in the spring and summer.

RSV, influenza, and all other routine illnesses were suppressed dramatically by the masking and distancing protocols put in place to prevent transmission of SARS-CoV-2. Now that those protocols have been relaxed, we expect to see a significant uptick in routine illnesses. It is possible there will be a deviation from the normal seasonal patterns of illness as pathogens re-emerge. Anecdotally, we have seen a recent increase in cases of strep in the CMG patient population. This can happen at any time of year but more typically occurs in the fall and winter.

The return of routine illness is an indicator of increased human to human interaction absent mitigants of disease transmission. This is not a surprise given that many restrictions have been lifted. But it is also an indicator that there is now increased opportunity for transmission of SARS-CoV-2 relative to the preceding months. This does not bode well for the arc of the pandemic in the United States as the Delta variant takes hold.

Status of the Pandemic in the United States and the World (updated)

The situation in the United States improved slightly this week. The 7-day average of new cases, number of hospitalizations, average deaths per day and test positivity rate all fell.

The 7-day cumulative number of Covid-19 cases per 100,000 people in the United States currently stands at 28, steady from last week and down from 49, 56, 70, 91, 105, 126, and 147 the six weeks prior.

The 7-day average number of new cases per day in the United States is currently 13,400, down from 14,000 last week and 22,000, 27,000, 35,000, 44,000, 51,000, 60,000, and 70,000 the seven weeks prior. The United States recorded roughly 94,000 total new cases during the week. This represents 3.6% of all new cases worldwide. The United States has 4.25% of the world’s population.

The national test positivity rate decreased to 1.9% this week from 2.4% last week and 2.3%, 3.1%, 3.5%, 3.9%, and 5.0% the five weeks prior.

The number of people currently hospitalized with Covid stands at 21,000, down from 24,000 last week and 27,000, 31,000, 35,000, 39,500, 42,800, and 46,300 the six weeks prior.

An average of roughly 385 deaths per day were recorded in the United States this week, down from 415 per day last week and 490, 590, 610, 685, 695, and 710 the six weeks prior. As of Saturday morning, the pandemic had killed roughly 598,000 people in the United States.

Seven states saw an increase in cases this week: Wyoming, Utah, Missouri, Nevada, Arkansas, Tennessee, and Hawaii. The current top 10 states (cumulative 7-day case rate per 100,000 population): Wyoming 84, Colorado 70, Washington 70, Nevada 63, Utah 63, Missouri 56, Louisiana 56, Montana 56, Oregon 49, and Arkansas 42. Again, the national number is currently 28 cases per week per 100,000 people.

The per capita numbers in our region (cumulative 7-day case rate per 100,000 population) were roughly steady this week: Maryland 14 (steady from last week and down from 28, 35, 56, 77, 105, 126, and 161 the seven weeks prior), DC 14 (down from 21, 28, 35, 42, 63, 77, 98, 112, 119 and 140 the last ten weeks), and Virginia 14 (steady from last week and down from 28, 35, 49, 70, 84, 105, and 126 the seven weeks prior). DC, Maryland, and Virginia tied for 42nd on the list this week.

The caseload in the world as a whole decreased to 370,000 per day this week from 445,000 last week and 528,000, 616,000, 784,000, 799,000, and 816,000 the four weeks prior. Several counties in South America continue to have among the highest per capita caseloads in the world.

Over 40 populous nations have higher per capita rates of disease than the United States at the moment. The top 10: Uruguay (721 cases per 100,000 population this week), Bahrain 532, Argentina 392, Colombia 350, Chile 266, Mongolia 252, Kuwait 245, Paraguay 238, Costa Rica 238, and Brazil 217. Current numbers for countries initially hit hard by the pandemic last spring: Spain 77, UK 70, France 49, Italy 21, Germany 21, Japan 14, South Korea 4.

Status of the Pandemic in the Washington Area (updated)

New cases reported in DC averaged 16 per day this week, down from 24, 30, 38, 41, 63, 79, 99, 116, 118, and 140 the last ten weeks. To this point DC has documented roughly 49,175 cases and 1,132 deaths. New cases in Montgomery County averaged 11 per day this week, down from 24 per day last week and 21, 29, 41, 50, 81, 88, 121, 117 and 120 the nine weeks prior. Montgomery County has now recorded roughly 71,100 total cases and approximately 1,565 deaths.

Statistics – CMG Tests for Active Disease (updated)

CMG performed 241 tests for active disease this week, 2 of which were positive. This translates to a positivity rate of 0.8%, down from 1.9% last week and 3.6%, 1.5%, and 2.4% the three weeks prior. Of the 23,619 patients tested for active disease by CMG to this point in the pandemic, 462 have been positive. This translates to an overall positivity rate of 2.0%.