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CMG COVID-19 Weekly Update 4.11.21

New or Updated This Week:
Instructive Numbers From Israel and the UK (new)
Further Evidence of Strong Vaccine Response in Pregnant and Lactating Women (new)
CDC: Viral Transmission Via Touching Surfaces Possible But Very Unlikely (new)
Vaccines Coming for Ages 12-15? (new)
CMG/Moderna Pediatric Vaccine Trial Update (new)
Maryland Vaccine Program Status (updated)
DC Covid Vaccine Program Status (updated)
Status of the Pandemic in the United States (updated)
Status of the Pandemic in the Washington Area (updated)
Statistics – CMG Tests for Active Disease (updated)
In-Person Well Visits at CMG (updated)
Pandemic Themed Virtual Group Visit Offerings (updated)

Hello again everyone. This is the 57th 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.

Instructive Numbers From Israel and the UK (new)

Israel and the UK had winter waves of viral activity that were among the worst in the world. Though the situation in the US was also dire at the time, Israel and the UK had rates of disease 20-30% higher than the US at its peak. The discrepancy is likely due to the fact that viral variant B.1.1.7 was predominant at the time in Israel and the UK, whereas it was rare in the US. B.1.1.7 is now becoming predominant in the US, however. Case rates here plateaued 6 weeks ago and have inched up in the last few weeks. This has lead to concern that the US may be headed for another major surge in cases. While this is certainly possible (and will depend in large part on the diligence with which the unvaccinated US population approaches prevention over the next month), data from Israel and the UK suggest the ongoing vaccine program in the US is likely to have a significant impact on viral transmission in the near future.

Israel leads the world in vaccination at the moment. According to a New York Times database, 60% of Israel’s population has received at least one dose, and 55% are fully vaccinated. The UK is also among the world leaders, with 48% of its population partially vaccinated and 9.2% fully vaccinated (the UK has taken the approach of increasing the time between doses in order to get as many people as possible a first dose quickly). In the US, by comparison, 34% are partially vaccinated and 20% fully vaccinated. It will take another several weeks for the US to get to where Israel and the UK are currently.

All three countries saw a precipitous drop in caseload from peaks in early January through mid-February. What happened thereafter may be instructive for the US. The case rate in the UK plateaued in March but has resumed a steep decline in April. Its per capita case rate is now 1/5 that of the US. Israel’s case rate plateaued in late February at a level more than twice the current US rate, and for a short time increased. Since that time, however, its case rate has fallen steadily and dramatically. Its case rate is now 1/6 that of the US.

Vaccination percentage is not the only variable determining the rate of transmission in a population, but it is an important one. It may turn out that approaching the 50% threshold of partial population vaccination (half the population having at least one dose) is what’s needed to resume a decline in ongoing viral transmission.

If the US does a reasonable job curtailing exposure among the unvaccinated over the next month, we may be able to keep case rates approximately where they are despite the spread of the more contagious viral variants. We could then expect to see a significant decline in caseload thereafter. If the attitude in the US is more cavalier, however, we could see significant worsening for a time before things get better.

Further Evidence of Strong Vaccine Response in Pregnant and Lactating Women (new)

A recent paper in the American Journal of Obstetrics & Gynecology provides further evidence that immunization with mRNA vaccines during pregnancy and lactation leads to a robust immune response, including the presence of antibodies in both umbilical cord blood and breastmilk.

In this study 131 women of reproductive age (84 pregnant, 31 lactating, 16 non-pregnant) received either the Moderna or Pfizer/BioNTech mRNA vaccines. Among the pregnant participants, 13% were vaccinated during the first trimester, 46% during the second trimester, and 40% during the third trimester. Antibody levels were measured in the breastmilk of those lactating and in the blood of all subjects at baseline, at the time of the second vaccine dose, 2-6 weeks after the second dose, and at delivery. Umbilical cord blood was tested for antibodies at delivery.

The authors found that vaccination led to equivalent levels of antibody in the pregnant and non-pregnant study participants. All participants generated significantly higher levels of antibody than a comparison group of 37 pregnant women who had been previously infected but not vaccinated. This is consistent with many other studies that have shown higher antibody levels in those vaccinated than those infected, and indicates that vaccination while pregnant induces a strong immunological response.

Antibody was also present in all samples of cord blood and breastmilk. This confirms previous study findings that maternal antibody can be passed to the developing baby through the umbilical cord and to the neonate through the breastmilk.

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend that Covid-19 vaccines “should not be withheld from pregnant individuals” and should be offered to those who are lactating. It is clear that vaccination can help protect pregnant and lactating individuals and their babies. If you are pregnant or lactating and have not been vaccinated, we strongly encourage you to discuss vaccination with your physician.

CDC: Viral Transmission Via Touching Surfaces Possible But Very Unlikely (new)

The CDC this week updated its guidance regarding the likelihood of contracting SARS-CoV-2 by touching a contaminated surface. While it is theoretically possible to contract the virus this way, the CDC report suggests it is not likely.

It has been clear for some time that the primary route of SARS-CoV-2 transmission is the inhalation of viral particles previously exhaled by an infected individual. Inhalation is an extremely efficient way to introduce viral particles to the body. Introduction by touch is far less efficient and requires the “successful” completion of a multi-step process: the deposition and survival of viral particles on a surface, followed in relatively short order by the touching of that surface, the transmission of viral particles from surface to hand, and finally the subsequent transmission from hand to mouth, nose, or eyes in sufficient quantity to cause infection. Per the CDC report, quantitative microbial risk assessment studies suggest this is such an inefficient means of viral transfer that “each contact with a contaminated surface has less than a 1 in 10,000 chance of causing an infection.”

We still recommend practicing good hand hygiene (regular washing or use of sanitizer) so that any viral particles on the hands are removed or denatured before the hands touch the face. The most essential element of prevention, however, remains the routine use of a well fitting mask.

Vaccines Coming for Ages 12-15? (new)

Pfizer/BioNTech on Friday requested that the FDA expand its Emergency Use Authorization for their vaccine to include adolescents aged 12-15. This request is based on data from Pfizer’s ongoing Phase 3 trial in this age group. In this trial roughly 1,100 participants were given two doses of vaccine 3 weeks apart while an equal number received placebo. To this point there have been 18 cases of symptomatic disease reported among participants in the trial, all of which occurred in the placebo group. Antibody production in response to the vaccine appears to be greater in the 12-15 age group than the 16-25 age group. No safety concerns have been reported to this point.

Assuming there is no interim change in the data, we expect the FDA will approve vaccination for this age group in the coming weeks or months. It is very likely this age group will have access to vaccination before the 2021-2022 school year begins.

CMG/Moderna Pediatric Vaccine Trial Update (new)

We are not yet sure when our participation in Moderna’s KidCOVE pediatric vaccine trial will begin. The trial is still in its earliest stage – determining which dose is appropriate for the 6-11 year age group. This involves giving one of two doses of vaccine to a very small number of children and assessing immunogenicity and side effect profile. We are not involved in this portion of the trial. Once a dose has been selected for this age group (likely a few moths from now), a much larger number of children will be enrolled to receive either the vaccine or placebo. We will certainly be participating in this stage of the trial. We may yet be selected to participate in the initial dose-selection phases of the trial for the younger age groups: age 2-5 years, and age 6-23 months. We will of course update you here when we have more information to share. There is not yet a mechanism to indicate interest in participating in the trial. We will share that information here as well as soon as it is available.

Maryland Vaccine Program Status (updated)

Starting Monday, all Maryland residents age 16+ will be 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 Montgomery County run vaccine sites can be found here.

DC Covid Vaccine Program Status (updated)

Starting Monday, all DC residents age 16+ will be 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 (updated)

The situation in the United States worsened by some measures this week, though the indicators were mixed. The per capita infection rate nationally remained steady, while the 7-day average of new cases and hospitalizations increased slightly. Test positivity rate and average deaths per day decreased.

The 7-day cumulative number of Covid-19 cases per 100,000 people in the United States currently stands at 140, steady from last week and up from 126 and 112 the two weeks prior.

The 7-day average number of new cases per day in the United States is currently 68,000, up from 65,000, 61,000 and 54,000 the last three weeks. The United States recorded roughly 475,000 total new cases during the week. This represents 10.7% of all new cases worldwide. The United States has 4% of the world’s population.

The national test positivity rate decreased to 4.7% this week from 4.9% last week. This compares to 4.5% and 3.9% the two weeks prior.

The number of people currently hospitalized with Covid stands at 44,000, up from 41,500 last week and 40,500 each of the two weeks prior.

An average of roughly 660 deaths per day were recorded in the United States last week, down from 850, 1,020 and 1,050 the three weeks prior. As of Saturday morning, the pandemic had killed roughly 561,000 people in the United States.

The 10 states with the highest cumulative 7-day case rates per 100,000 population at the moment are all on the East Coast or in the Midwest. Michigan continues to see a particularly rapid increase in cases has a high percentage of variant B.1.1.7, and is now near its winter peak caseload. The current top 10: Michigan 532, New Jersey 308, Rhode Island 266, New York 266, Pennsylvania 245, Minnesota 245, Delaware 224, New Hampshire 217, Connecticut 217, and Massachusetts 210. Again, the national number is currently 140 cases per week per 100,000 people.

The per capita numbers in our region were mixed this week: Maryland 154 (up from 147, 126, 105, 98, and 84 the five weeks prior), DC 119 (down from 140 last week and compared to 112 and 105 the two weeks prior), and Virginia 119 (unchanged from the last three weeks). Maryland, DC and Virginia rank 18th, 25th and 25th on the list this week.

Over 40 populous nations have higher per capita rates of disease than the United States at the moment. The top 10: Uruguay (763 cases per 100,000 population this week), Bahrain 497, Sweden 434, Turkey 420, West Bank/Gaza 385, Serbia 378, Poland 371, Jordan 364, Hungary 357, and Estonia 357. Current numbers for countries initially hit hard by the pandemic last spring: France 294, Italy 175, Germany 126, Spain 119, UK 28, Japan 21, South Korea 3.

Status of the Pandemic in the Washington Area (updated)

New cases reported in DC averaged 118 per day this week, down from 140 last week and compared to 113 and 107 the two weeks prior. To this point DC has documented roughly 45,650 cases and 1,080 deaths. New cases in Montgomery County averaged 117 per day this week, down from 120 last week and compared to 118, 111 and 103 the three weeks prior. Montgomery County has now recorded roughly 67,850 total cases and approximately 1,490 deaths.

Statistics – CMG Tests for Active Disease (updated)

CMG performed 810 tests for active disease this week, 10 of which were positive. This translates to a positivity rate of 1.2%, down from 3.1%, 2.6%, 3.3% and 2.1% the four weeks prior. Of the 21,406 patients tested for active disease by CMG to this point in the pandemic, 430 have been positive. This translates to an overall positivity rate of 2.0%.

In-Person Well Visits at CMG (updated)

We are happy to report that CMG’s providers and staff are now all 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.

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.

Sign up for the whole 4-session series or drop in for one session.

Monday, 4/19, 10:30-11:30am - focus on Feeding

Monday 4/26, 10:30-11:30am - focus on Sleeping

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)