CMG COVID-19 Weekly Update 11.14.21

New or Updated This Week:

CMG Covid Vaccine Clinic for Ages 5-11 Saturday 11/20, By Appointment (new)
Europe as Harbinger for the United States; Recommendations in Advance of the Next
Wave (new)
Moderna/CMG Pediatric Vaccine Trial for Children 6 Months to 5 Years (updated)
Flu Vaccine Still Available at CMG in Office (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 Group Virtual Visit Offerings – On Hiatus (updated)
Hello again everyone. This is the 83rd 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. 

CMG Covid Vaccine Clinic for Ages 5-11 Saturday 11/20, By Appointment (new)

We are happy to report that CMG will be receiving several hundred doses of Pfizer’s Covid vaccine for children age 5-11 this week. We will be conducting a vaccine clinic for CMG patients in this age group Saturday 11/20 from 8-2:30 in the building’s second underground parking level. This clinic will be by appointment only. Appointments must be made using this link.Children in the office for well visits this week will not be able to receive vaccine at that time – the only opportunity will be at the clinic on Saturday. This is to ensure that every dose gets used and none are wasted. We hope to be able to offer Covid vaccine at well visits in the future when there is a surplus of vaccine.

If you have more than one child, please make a separate appointment for each child to be vaccinated. We will not be able to vaccinate those without appointments or those who have not yet turned 5. This will be a pediatric Covid vaccine clinic only – due to logistical and staffing constraints we will not be able to offer flu vaccine or adult Covid vaccine during this clinic. 

We know this initial clinic will be insufficient to cover all of our patients, and apologize in advance if you are unable to get an appointment. We expect to receive additional vaccine in future weeks and will add opportunities for vaccination when we are able. However, there is no need to wait for vaccination at CMG – if Saturday doesn’t work for you or you are unable to get an appointment, please seek vaccination wherever you are able.

Europe as Harbinger for the United States; Recommendations in Advance of the Next Wave (new)

Europe has once again become the epicenter of the pandemic. Case rates there have been increasing for the last 6 weeks, fueled by the Delta variant. Among populous nations, the top 17 in case rate per capita at the moment are all in Europe. Each of these countries has a case rate 2 to 5 times that of the United States. Germany this week recorded more new cases than at any time in the pandemic. 

Though the case rate in the United States is currently down more than 50% from its Delta peak in September, viral transmission in the U.S. increased significantly this week for the first time in two months. We feel this signals the beginning of a second Delta wave in the United States, and that Europe’s experience over the last two months is predictive of what is likely to unfold here moving forward. Unfortunately, there is reason to believe a second Delta wave in the US may result in case rates equal to or greater than those currently occurring in Europe. 

Many of the European nations experiencing heavy caseloads right now have higher vaccination rates than the United States and are further along in their booster campaigns. Belgium has a 74% vaccination rate (as compared to 59% in the United States), yet currently has a per capita case rate three times that of the U.S (75 cases per day per 100,000 population in Belgium vs 24 per day in the U.S.). Austria has 63% of its population vaccinated, yet more than 4 times the U.S per capita case rate. Similar for Ireland: 76% vaccinated, 3 times the U.S. case rate. The UK has 69% vaccinated yet has had fluctuating but consistently high case rates since July; currently its caseload is more than twice that of the U.S. These statistics suggest the potential exists for a significant increase in caseload in the United States over the next few months as people travel for the holidays and spend more time indoors with one another. 

If another Delta wave develops, breakthrough infections among those vaccinated 6 months ago or more who are not yet boosted will become more frequent. Repeat infections among those infected last winter who have not subsequently been vaccinated are also likely to increase. While prior infection with a non-Delta strain generates an immune response that is protective, that protection has been shown to wane over time and to be less protective against Delta specifically. A preprint study in medRxiv this week examined antibody and T cell activity 12 months after mild Covid-19 infection. The patients in the study had been infected prior to the emergence of Delta. Though the majority still retained antibodies and T cells directed at the SARS-CoV-2 spike protein, only 16% had antibodies capable of neutralizing Delta. T cell function against Delta was also found to be severely limited.

Fortunately, breakthrough infections among the vaccinated and among those previously infected remain less common than among the unvaccinated, and far less likely to be lethal. Statistics from the Texas Department of State Health Services indicate that from September 4 through October 1, the unvaccinated in Texas were 13 times more likely to become infected and 20 times more likely to die from Covid-19 than the fully vaccinated. Among those in their 40’s, the unvaccinated were 55 times more likely to die from Covid-19 than were the vaccinated.

Given the likelihood of increasing viral activity in the United States, we think it would be wise public health policy to approve booster doses for all patients who are six months out from their initial series, regardless of age. Colorado and California approved boosters for everyone age 18 and up this week. We expect more states to follow suit as time goes on and infections increase. 

In our opinion boosters should also be approved for those age 12-17 who were vaccinated last spring. This is not because we are worried about severe disease in this cohort (this will occur extremely rarely among those who have received two doses), but because data from Israel suggests vaccinating this age group can drive down the overall rate of disease in the community. CMG will not be able to offer booster vaccines to adolescents until they are approved by the State of Maryland.

If you are not yet vaccinated, we once again implore you to become so. If you have had Covid but have not been vaccinated, we recommend at least one dose of either the Pfizer or Moderna vaccine. For children 5-11, we recommend vaccination at the earliest opportunity. For those who have been fully vaccinated for 6 months or more and are eligible, we strongly recommend a booster dose.

Moderna/CMG Pediatric Vaccine Trial for Children 6 Months to 5 Years (updated)

We continue to enroll children age 6 months to 5 years in Moderna’s KidCOVE vaccine trial.  Enrollment will be ongoing for the next 2-4 weeks. ¾ of the children who enroll will receive 2 doses of vaccine one month apart. The other ¼ will receive placebo. The vaccine dose is 25 micrograms, one-fourth the adult Moderna dose. This is a double blind study, meaning neither the families nor the doctors will know which children receive vaccine and which receive placebo. If you would like to indicate interest in enrolling your child(ren) and have not yet done so, please fill out an interest form. Only one interest form is needed per family – multiple children can be registered on the same form.

If during the course of the study either Pfizer or Moderna receives an Emergency Use Authroization for this age group, the study will become unblinded. In this event parents will be told whether their children received vaccine or placebo, and the placebo group will be offered vaccine as part of the study. 

Flu Vaccine Still Available at CMG in Office (updated) 

CMG’s parking lot-based flu clinics have concluded, but we will continue to offer flu vaccine in the office. To book an appointment, please follow this link. We recommend that everyone age 6 months and older to receive flu vaccine annually.

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

The situation in the United States worsened this week. 26 states saw an increased caseload, including 19 with an increase of 20% or more over the last 14 days (Minnesota, New Mexico, Colorado, New Hampshire, Vermont, Michigan, Wisconsin, Arizona, Nebraska, Iowa, Ohio, Kansas, Indiana, Rhode Island, New York, Illinois, Massachusetts, Nevada, and Missouri). The average number of new cases per day and test positivity increased. Hospitalizations and deaths per day decreased slightly; these lagging indicators will start rising again in the next several weeks if total cases per day continue to increase.

The 7-day cumulative number of Covid-19 cases per 100,000 people in the United States currently stands at 168, up from 154 each of the last two weeks.

The 7-day average number of new cases per day in the United States is currently 79,000, up from 72,000, 73,000 and 74,000 the last three weeks. The United States recorded roughly 555,000 total new cases in the last week. This represents 17.0% of all new cases worldwide. The United States has 4.25% of the world’s population. 

The national test positivity rate currently stands at 5.3%, up from 5.2% and 5.0% the last two weeks. 

The number of people currently hospitalized with Covid stands at 46,000, down from 47,000 last week and 51,000, 54,000, 62,000, 68,000, 75,000, 85,000, 95,000 and 102,000 the eight weeks prior.

An average of roughly 1,120 deaths per day were recorded in the United States this week, down from 1,200 last week and 1,375, 1,500, 1,585, 1,770, 1,880, and 2,060 the six weeks prior. As of Saturday morning, the pandemic had killed roughly 761,000 people in the United States.

The current top 10 states (cumulative 7-day case rate per 100,000 population): Minnesota 469, North Dakota 448, New Mexico 448, Colorado 441, Alaska 413, New Hampshire 392, Vermont 385, Wyoming 371, Michigan 371, and Wisconsin 371. Again, the national number is currently 168 cases per week per 100,000 people. 

The per capita numbers in our region increased slightly this week. Cumulative 7-day case rate per 100,000 population: Maryland 84 (up from 77 last week and compared to 91 each of the two weeks prior), DC 84 (up from 77 last week and compared to 91 and 84 the two weeks prior), and Virginia 112 (up from 105 last week and compared to 119 and 140 the two weeks prior). Virginia, Maryland and DC rank 38th, 42nd and 43rd out of the 51 states plus DC on the list this week.

Roughly 30 populous nations have higher per capita rates of disease than the United States at the moment. The top 10: Slovenia (1,057 cases per 100,000 population this week), Croatia 938, Georgia 868, Austria 784, Slovakia 735, Lithuania 644, Czech Republic 616, Estonia 595, Ireland 560, and Belgium 525.

Status of the Pandemic in the Washington Area (updated)

New cases reported in DC averaged 82 per day this week, up from 80 last week and compared to 93, 87, and 101 the three weeks prior. To this point DC has documented roughly 65,370 total cases and 1,194 deaths. New cases in Montgomery County averaged 79 per day this week, up from 75 last week and 76 the week prior. Montgomery County has now recorded roughly 82,300 total cases and approximately 1,673 deaths.

Statistics – CMG Tests for Active Disease (updated)

CMG conducted 418 tests for active disease this week, 10 of which were positive. This translates to a positivity rate of 2.4%, up from 1.2% last week and 1.8%, 1.2, 1.4%, and 1.5% the four weeks prior. CMG’s average positivity rate for the duration of the pandemic is 2.0%.

Pandemic Themed Group Virtual Visit Offerings – On Hiatus (updated)

Our virtual group visits will be on hiatus this week. We hope to bring them back in the near future.