CMG COVID-19 Weekly Update 5.1.21

New or Updated This Week:
The Situation in India (new)
Should We Be Fazed by an Increase in the Percentage of Cases Occurring in Children? (new)
Evidence That Maternal SARS-CoV-2 Infection During Pregnancy Does Not Directly Harm the Developing Fetus (new)
No News on Approval of Vaccine for 12-15 Year Olds (new)
CMG/Moderna Pediatric Covid Vaccine Trial Update and How to Register Interest (updated)
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)
Pandemic Themed Virtual Group Visit Offerings (updated)

Hello again everyone. This is the 60th in a series of weekly COVID-19 updates from Capitol Medical Group. We will send a notice like this each weekend to give you 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.

The Situation in India (new)

India has been in a phase of exponential Covid case growth over the last month. This week India recorded over 2.5 million new cases, 400,000 on Saturday alone. Even these astronomical numbers are surely an undercount, as many people do not have access to testing. In the United States we believe the number of true infections exceeds the number of reported infections by a factor of 3-5. If this is also true in India, where the proportion of unreported cases may actually be higher, the true number of new cases this week may have been as high as 10-20 million.

This is an overwhelming absolute number of cases, but because India’s population is so large (nearly 1.4 billion), and perhaps because of under-reporting, India’s per capita numbers are still not as high as many other countries at their respective peaks. India is currently reporting 264 cases per million people per day. Israel peaked at 996 cases per million in January. Its current rate, with 60% of its population at least partially vaccinated, is 10 cases per million per day. The UK peaked at 881 cases per million per day in January. Its current case rate, with 51% of its population partially vaccinated, is 33 cases per million per day. The US peak in January was 758 cases per million per day. It is now at 152 cases per million per day with 43% of its population partially vaccinated. India currently has 9% of its population partially vaccinated, and just 2% fully vaccinated.

India is thought to have two variants circulating widely: B.1.1.7 and B.1.617. Both contain mutations that enable more rapid transmission and potentially greater lethality. The vaccines protect well against both strains, but because only a small percentage of India’s population has been vaccinated they are not likely to curb the current surge. The peak in the United States in January was not fueled by B.1.1.7 or any of the other more transmissible variants. If not for the vaccine program in the United States, the mini-surge of cases we experienced in April as B.1.1.7 took hold would almost certainly have been worse and may well have approached or exceeded the winter peak.

India has become so overwhelmed with cases that it is suffering the “breakdown” of the health care system feared in many countries: lack of available rescue services, hospital beds, ventilators, and oxygen. This will drive up the mortality rate substantially, both for Covid and for other medical conditions.

India is by no means the only country suffering at the moment. Parts of South America, the Middle East, and Europe are also struggling to contain major outbreaks driven by the viral variants. We are extremely fortunate in the United States to have access to vaccination that protects against all known strains of the virus. If you are 16 and over and not yet vaccinated we urge you to become so at the earliest opportunity.

Should We Be Fazed by an Increase in the Percentage of Cases Occurring in Children? (new)

According to the American Academy of Pediatrics, 13.7% of all reported US cases to this point in the pandemic have occurred in children. That number has climbed above 20%, however, in recent weeks. The increase in pediatric cases relative to adults was noted in Michigan during its recent surge and has also been reported in Colorado this week as case numbers rise there.

This change is likely attributable to a combination of factors. The first is the ongoing vaccine program in adults and older teens. As more adults acquire immune protection, children make up a greater percentage of the susceptible population and therefore can be expected to account for a greater percentage of infections. An increase in the percentage of pediatric cases for this reason alone should not be cause for concern.

The opportunity for children to interact has increased as vaccinated adults change their patterns of behavior and society opens more fully. Increased family and friend visitation and the resumption of sports and other activities will continue to give children more opportunities to be with one another physically. While this is an extremely welcome development overall, it does come with some risk. If the unvaccinated become less attentive to mitigation measures when they are together, especially indoors, those who are harboring the virus will transmit it to a greater number of people on average.

This phenomenon will aided by the spread of variant B.1.1.7, which is now the predominant strain in the US. This variant is clearly more transmissible in adults, and is likely more transmissible in children as well. The vaccines protect against this strain extremely well, but children under 16 are not yet eligible for vaccination. The continued spread of B.1.1.7 in the context of fewer and fewer susceptible adults will certainly contribute to the increase in percentage of cases among children. It is not yet clear whether B.1.1.7 causes greater severity of disease in children.

Though we expect the overall rate of disease in the United States to fall significantly in the coming months, the proportion of cases occurring in children may rise to some degree. This will not necessarily be cause for concern. More worrisome would be an increase in the total number of pediatric cases while the numbers in adults fall, and especially an increase in severity of disease among children. If either occurs, we will revisit in this space.

Evidence That Maternal SARS-CoV-2 Infection During Pregnancy Does Not Directly Harm the Developing Fetus (new)

A study published in JAMA this week suggests that babies born to mothers who contract SARS-CoV-2 during pregnancy are not directly harmed by the virus in utero. The authors of this study reviewed over 88,000 births occurring in Sweden from March 2020 through January 2021. Of these, over 2,300 babies were born to mothers who tested positive for SARS-CoV-2 during pregnancy. Each of these babies was matched to 4 babies born to SARS-CoV-2 negative mothers with similar characteristics. Neonatal outcomes were then compared in the two groups.

The authors did find increased rates of several complications among the babies born to the SARS-CoV-2 positive mothers. These newborns were statistically more likely to require assisted ventilation at birth, admission for neonatal care, to develop a respiratory disorder, and to develop jaundice than were babies born to the SARS-CoV-2 mothers. However, statistical analysis showed that these increased risks were not due to viral harm in utero, but rather to the fact that these babies were more likely to be born early. 8.8% of these babies were born before 37 weeks gestation, as compared to 5.6% of the babies born to SARS-CoV-2 negative mothers. It was this greater likelihood of premature delivery that yielded the greater propensity for complications in the babies born to SARS-CoV-2 positive mothers.

While it is not great that infected mothers appear to have a greater likelihood of early delivery, it is very welcome news that maternal infection does not appear to harm the babies directly in utero. This matches observational data during the pandemic that babies born to positive mothers appear relatively unaffected.

No News on Approval of Vaccine for 12-15 Year Olds (new)

Pfizer applied for an Emergency Use Authorization for its vaccine in children 12 and up three weeks ago. At the time of this writing the FDA has not indicated when a decision on this application can be expected. The timeline for review of previous vaccine applications has been roughly three weeks, so we are hopeful a decision will be coming shortly.

CMG/Moderna Pediatric Covid Vaccine Trial Update and How to Register Interest (updated)

We are happy to report that CMG has been selected to participate in Part 1 of Moderna’s KidCOVE vaccine trial for children ages 6 months to 11 years. We expect to be able to enroll a small number of participants for this portion of the study starting in late May.

The goal of Part 1 is to determine the appropriate vaccine dosage for each of the three age groups. Each child enrolled in this portion of the trial will receive two doses of the actual vaccine one month apart. None will receive placebo. Participants in this stage will receive one of two or three different microgram strengths of vaccine depending on the age group.

We are now accepting initial Interest Forms to plan for enrollment. Enrollment will occur in stages as the various “arms” of the study progress. We will endeavor to enroll as many interested families as we can, though the number we can enroll in Part 1 will be strictly limited by Moderna. When we get the go-ahead to begin enrolling patients for Part 1, we will begin reaching out to families that have expressed interest.

Data from Part 1 of the trial will later be used to select the microgram strength of vaccine that will be used for each age group in the much larger Part 2 of the trial. In Part 2, two thousand participants in each age group will be randomized to receive either vaccine or placebo in a 3:1 ratio. CMG will be able to enroll a much larger number of children in this part of the trial. The first age group to enter Part 2 will be the 6 to 11 year age group, likely in August. The 2-5 year old age group is expected to move into Part 2 in the fall, and the 6 month-23 month age group in the first quarter of 2022.

If you would like to indicate interest in participating in the study, please fill out a single Interest Form for your family (multiple children can be entered on a single form). We will provide further updates in this space as we receive additional information from Moderna. In the meantime, please continue to refrain from contacting the office about the study, as we do not have additional details to share. Thank you for your understanding and patience as we work with Moderna to get this exciting study up and running at CMG.

Maryland Vaccine Program Status

All Maryland residents age 16+ are now eligible for vaccination at any vaccine site in the state. Links to pre-register at mass vaccination sites and to find availability at other sites can be found here. Links to County-run vaccine sites can be found here.

DC Covid Vaccine Program Status

All DC residents age 16+ are now eligible for vaccination as well. A link for DC residents to preregister can be found here. This site also has information about vaccination opportunities through pharmacies and community health centers.

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

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

The 7-day cumulative number of Covid-19 cases per 100,000 people in the United States currently stands at 105, down from 126 last week and 147, 140 and 140 the three weeks prior.

The 7-day average number of new cases per day in the United States is currently 51,000, down from 60,000 last week and 70,000, 68,000, 65,000, and 61,000 the four weeks prior. The United States recorded roughly 355,000 total new cases during the week. This represents 6.2% of all new cases worldwide. The United States has 4% of the world’s population. New cases in the US as a percentage of total new cases worldwide has been dropping steadily for some time.

The national test positivity rate decreased to 3.9% this week from 6.0% last week and 5.2%, 4.7%, 4.9%, 4.5% and 3.9% the five weeks prior.

The number of people currently hospitalized with Covid stands at 42,800, down from 46,300 last week and 45,500 and 44,000 the two weeks prior.

An average of roughly 695 deaths per day were recorded in the United States this week, down from 710 per day last week and compared to 700, 660, 850, 1,020 and 1,050 the five weeks prior. As of Saturday morning, the pandemic had killed roughly 575,000 people in the United States.

Michigan continues to have the highest per capita case rate in the nation by a significant margin, but saw a substantial decrease in new cases again this week. Parts of the Mountain West and Pacific Northwest saw increases this week. The current top 10 states (cumulative 7-day case rate per 100,000 population): Michigan 301, Colorado 210, Minnesota 196, Pennsylvania 189, Delaware 189, Rhode Island 175, Florida 175, New Jersey 168, Illinois 147, and Alaska 147. Again, the national number is currently 105 cases per week per 100,000 people.

The per capita numbers in our region improved again this week: Maryland 105 (down from 126, 161, 154, and 147 the last four weeks), DC 77 (down from 98, 112, 119 and 140 the last four weeks), and Virginia 84 (down from 105, 126, 119 and 119 the last four weeks). Maryland, Virginia and DC rank 23rd, 31st, and 39th on the list this week.

The situation in the world as a whole continues to be as bad as its been to this point. This week the world recorded an average of 816,000 new cases per day, steady from last week. The numbers continue to be driven by India, which has averaged nearly 365,000 newly identified cases per day over the last week and recorded over 400,000 new cases Saturday alone. The situation is also dire in parts of South America and Europe.

Roughly 50 populous nations have higher per capita rates of disease than the United States at the moment. The top 10: Bahrain (469 cases per 100,000 population this week), Uruguay 469, Sweden 343, Argentina 343, Croatia 329, Turkey 322, Netherlands 308, Lithuania 287, France 259, and Colombia 238. Current numbers for countries initially hit hard by the pandemic last spring: France 259, Italy 147, Germany 140, Spain 119, Japan 28, UK 21, South Korea 7.

Status of the Pandemic in the Washington Area (updated)

New cases reported in DC averaged 79 per day this week, down from 99, 116, 118, and 140 the last four weeks. To this point DC has documented roughly 47,700 cases and 1,105 deaths. New cases in Montgomery County averaged 81 per day this week, down from 88, 121, 117 and 120 the last four weeks. Montgomery County has now recorded roughly 69,850 total cases and approximately 1,520 deaths.

Statistics – CMG Tests for Active Disease (updated)

CMG performed 209 tests for active disease this week, one of which was positive. This translates to a positivity rate of 0.5% as compared to 0.0% last week and 2.1%, 1.2%, 3.1%, 2.6%, 3.3% and 2.1% the six weeks prior. We hope the drop in positive tests the last two weeks represents the beginning of a significant downward trend attributable to the growing vaccine penetration in our patient community. There is a real chance this is the case, but it is still too early to know for sure. Of the 22,365 patients tested for active disease by CMG to this point in the pandemic, 439 have been positive. This translates to an overall positivity rate of 2.0%.

In-Person Well Visits at CMG

We are happy to report that CMG’s providers and staff are now all at least two weeks out from their second dose of vaccine. At this point, we would prefer that well visits for all ages occur in-person in the office. If you currently have a virtual well visit on the schedule and are willing to come in to the office instead, no action is needed on your part - we will automatically convert the visit to an in-person visit at the same time with the same provider. If you are not comfortable coming to the office and would prefer to have a virtual well visit, please let us know. Most sick visit types will remain virtual for the time being, to be followed as needed by an in-person exam. Some competitive athletes will need to have an in-person exam for sports clearance if it has been over a year since their last in-person exam or if they have a history of Covid infection.

Pandemic Themed Virtual Group Visit Offerings (updated)

Please see below the schedule for upcoming Virtual Group Visit offerings. All sessions will take place on Zoom. We expect most sessions to have between 4 and 15 participants. The sessions are meant to be participatory, but if you prefer to keep your camera off and your microphone muted, you are welcome to do so. Questions can be posed directly by voice, or indirectly through the chat function. Sessions will be billable to insurance as would a normal visit with your provider.

If there is a session you would like to join, please email This email address is being protected from spambots. You need JavaScript enabled to view it. or call the office at 301-907-3960. Please include the name and date of birth of the patient, the session you would like to join, the provider who is leading it, the day and the time. We look forward to seeing you online!

New Parent Group -- Zoom version! Dr. Ana Markovic & Lactation/Feeding Consultant Holly McClain, RN, Mondays 10:30-11:30. See detailed schedule below.

Formerly "Mommy and Me,” and now open to both Dads and Moms.

Virtual parent support group session starting at CMG! This group is ideal for parents of 2 week to 4 month old babies. Weekly sessions will be led by Pediatrician Ana Markovic and Lactation/Feeding consultant Holly McClain. Each week we will focus on a different topic, though we will also cover any particular topics of interest to the group that day. Topics include breastfeeding and feeding support, discussion about sleep strategies, nutrition, finding balance, infant development, and most of all getting to know other new parents and sharing experiences. Our traditional ways of connecting with each other have been turned upside down and this will hopefully be a welcome source of information as well as an opportunity to connect with others who may be in a similar situation.

Monday, 5/3, 10:30-11:30am - special session on Infant Massage

Monday, 5/10, 10:30-11:30am - focus on Infant Development (0-12 months)

Summer 2021: Travel and Camp Planning – Dr. Dan Finkelstein, Wednesday 2-2:45

Many people are contemplating a more active summer this year, though younger children will not yet be vaccinated. This session will address decision making with regard to typical summer activities in the context of this stage of the pandemic. Air travel, joint vacations, day camps and sleep away camps will be discussed. Questions and discussion welcome.

What Can We Do Together at This Point? Dr. Dan Finkelstein, Thursday 2-2:45

Given the state of vaccination, we are all trying to figure out who can do things with who, and how. This session will provide an opportunity to discuss planning for joint activities for each permutation – groups that are all vaccinated, mixed groups of vaccinated and unvaccinated, and groups where none are yet vaccinated. Questions and consideration of particular scenarios welcome.