January 20, 2021

What Are Covid Long Haulers?

Some update on Long Haulers (also called Post-acute Covid-19 Syndrome):  I first wrote about Long Haulers in September, and now there is more information about these patients who had documented Covid-19, but are still symptomatic, and virus negative.  Fatigue is one of the major symptoms, but there is a constellation of symptoms that persist for months and interfere with normal living.  It can occur in patients hospitalized with severe disease or even young people with mild acute infections. If more young people knew about these chronic symptoms, fewer would take risks thinking they would have a mild illness with complete recovery. 

Some recent studies estimate that 10% of Covid-19 patients become long haulers with fatigue, insomnia, shortness of breath, "brain fog,"  lack of smell and taste, depression, myalgias, arthralgias, headache, intermittent fever, and heart palpitations or rapid rate.  There are multiple theories about the cause of these symptoms, but much more data needs to be collected and studies done. Anthony Fauci thinks that some of these patients with symptoms lasting longer than 4 weeks after their virus clears, may develop chronic fatigue syndrome (myalgic encephalomyelitis).  

 

 

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Patients frequently had problems convincing doctors that their lingering symptoms, which prevented them from going back to work or resuming their previous activities, were real.  In recent months Post-Covid Care Centers and support groups are seeing these patients.  Medical School hospitals are among those who are following a large number of patients and collecting longitudinal data to share with other centers.   This is a good general reference for more information: https://www.scientificamerican.com/article/the-problem-of-long-haul-covid/

 

January 16, 2021

Third SARS-CoV-2 Vaccine: Johnson and Johnson

This week J and J published the full results from Phase 1 and 2a Trials on their SARS-CoV-2 vaccine.  These two types of trials are focused on Safety and ability to stimulate an Immune Response.  In these trials they tested multiple variables:  ages 18-55, ages 65+, low dose and high dose, and 1 versus 2 doses.  The vaccine was safe, with mostly low grade local and systemic symptoms (injection site pain, fatigue, headache, myalgia, rare fever).  Immunologic studies demonstrated a 90% immune response, including neutralizing antibodies against the virus.  In addition there was a T cell immune response.  Both age groups included slightly more than 400 volunteers.  Based on these two trials, J and J developed two Phase 3 clinical trials to assess the efficacy of 1 or 2 low doses of the vaccine.  Complete enrollment in the one dose trial was reported on Dec 17th.  An application to the FDA for an EUA requires that at least 50% of the volunteers must be 2 months beyond their vaccination for an adequate safety evaluation (probably Feb).  The 2 dose Phase 3 trial is still ongoing.  Unfortunately J and J says manufacturing is slow.  Read Below

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The virus in the above illustration is a harmless inactivated adenovirus that causes colds. 

The J and J vaccine is similar, but different from the mRNA vaccines by Pfizer and Moderna  The DNA code for synthesizing the SARS-CoV-2 spike protein is introduced into the cells of our body with a harmless adenovirus as the carrier.  There the DNA is a template for synthesis of the spike protein and our immune system responds to the spike proteins by developing antibodies and cellular immunity to SARS-CoV-2  J and J successfully made an ebola vaccine using this technique. Based on the results of the Phase 3 clinical trial it may only require one dose to achieve high levels of immunity and it can be stored in the refrigerator.

January 13, 2021

Allergic Reactions to mRNA Covid Vaccines?

Morbidity and Mortality Weekly Review (MMWR), a publication, of the CDC, reported on 21 cases of anaphylaxis between Dec 14-23rd following vaccination with the Pfizer vaccine.  Anaphylaxis can occur after any vaccination and these are cases from the first use of the Pfizer vaccine after their FDA Emergency Use Authorization was granted.  There were 1.9 million Americans who received the Pfizer vaccine during that period, for an incidence of 11.1 cases of anaphylaxis per million vaccinated.  These reports were sent to the CDC through multiple safety reporting methods, and after an initial review there were 175 cases that needed to be carefully assessed and only 21 cases of anaphylaxis were found. The diagnosis of anaphylaxis was based on a worldwide scientific system of classification of anaphylaxis.  17 of the patients had a history of allergies and 7 of the patients had a history of a prior anaphylactic episode. 

The median age of the patients was 40.  Ninety % were women.  The median interval to developing symptoms was 13 minutes with 14% occurring after 30 minutes.  All patients were treated with epinephrine and recovered.  One patient was lost to followup.  81% of these patients had a history of allergies: drugs, medical products, foods, insect stings.  These cases were spread geographically and none received vaccines from the same lot numbers.   

After review there were 83 cases of non-anaphylactic allergic reactions: itching, rash, itchy and scratchy symptoms in the throat, and mild respiratory symptoms.  67% of these patients had a past history of allergic symptoms. The remainder of the cases reviewed were non-allergic, i.e. like vasovagal syncope (fainting).

More below. 

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I watched the CDC broadcast on vaccine allergic reactions several weeks ago, mainly because  I have multiple allergies.  These are their recommendations:

1.  Any patient who has anaphylaxis to either the Moderna or Pfizer vaccine, should NOT be vaccinated again with those vaccines.

2.  Any patient who has a history of anaphylaxis to a prior vaccine (i.e. influenza etc) or to an IV drug should consult an allergist and their risk vs benefit ratio to vaccination assessed.

3.  Any patient with allergies to foods, animal danders, insect stings, meds (given orally), eggs, gelatin, and/or positive family history may receive the vaccines. 

Vaccination sites should screen patients for allergies, have medical resuscitation equipment and epinephrine in prefilled syringes available, and observe all patients with allergies for 30 minutes post vaccination, instead of 15 min.  Data from the Moderna vaccine experience will be reported soon.  Only one case of anaphylaxis was reported early as far as is mentioned in the press.

January 9, 2021

The Path Forward Combating Covid-19 - Dr. Francis Collins

I listened to an excellent interview of Francis Collins, Director of NIH and Dr. Fauci's boss, this week.  He talked about multiple aspects of the pandemic and I wanted to share some of that information. 

He did not accept the idea of giving only 1 dose, or two half doses of the current Pfizer and Moderna vaccines to spread out the vaccine.  The very high efficacy of these vaccines was obtained in clinical trials of 15,000 (Moderna) and 22,000 (Pfizer) volunteers using 2 full doses.  "Science must prevail" - there is no guarantee that the efficacy will remain high, especially in the different subgroups, if the dosing regimen is changed.  He also was hopeful that the current vaccines will be effective with the new mutations (UK and S.Africa), and this is being studied in the lab.  RNA viruses mutate all the time, and the US was not studying the genomic changes of isolated viruses like the UK.  The CDC has now set up a comprehensive genomic testing lab to follow the mutations.

The vaccinations started slowly, but this is partially understandable.  There is a learning curve for this as with anything else.  He wants to make sure that more than 1 million people are vaccinated per day with a goal of vaccinating 80-85% of the population to achieve herd immunity.  State Governors meet virtually, weekly, to share their experiences and advice with vaccine distribution.  He believes that vaccine availability might be the limiting step, but hopes to have the population vaccinated by summer.  See below

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There is still vaccine hesitancy in different groups.  The government developed many different ways to assure the public about the safety of the vaccines.  He stressed that dying of Covid-19 is a MUCH higher risk than having a side effect from the vaccine.   There are many different approaches being used to meet with groups of people through churches, community centers, and groups of community leaders to expand the number of people who will be vaccinated.  For those who wonder about historical distrust of the government re: "experiments," look up the Tuskegee Study in Wikipedia. 

Dr. Collins said that he speaks to Dr. Fauci every night and they both disseminate information using scientific facts.  One fact I want to emphasize:  After you are vaccinated you must still follow the Public Health guidelines until we achieve herd immunity.  We know that the vaccines were highly effective in the clinical trials, but you don't know if your personal immune response is as effective when the community virus rates are so high.  The virus will still be spreading until herd immunity is reached. 

 

 

 

January 6, 2021

A Brief Return to Figure Drawing - Virtually

I returned to non-Covid-19 figure drawing for the first time since February - this time virtually on ZOOM.  Simon Levinson of Drawing New York Meetup Group organized a Pride and Prejudice Reading as we sketched a model in a period costume.  These are 2 of the 4 drawings I did - and I really enjoyed the 2 hour session.  This will continue on Sundays in January - something different to look forward to, and I finally found my very old copy of Pride and Prejudice to read.  It is nice to take a break from pandemic art and science, although I will continue that when new topics seem important. 

A 7 minute pose 

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A 40 minute pose - with one break. 

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January 2, 2021

My Covid Year: March-December

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My blog will be 14 years old on Jan. 4th. I was partially retired and enjoying daily drawing in a sketchbook when I discovered Danny Gregory’s Everyday Matters Yahoo Group. It was the perfect inspiration for me, both for drawing and playing with watercolor paint. After following the Yahoo Group for several months, I decided to start a blog so I could share occasional sketchbook pages with the group. Each year, almost from the beginning, I wrote a blog post about my Progress throughout the year, and my specific Goals for the coming year - per recommendations from the EDM Group. That is impossible to do this year.

My Overall Goals always were: To develop better drawing and painting skills on paper, and dye-painting skills and surface design on fabric.

My specific goals for 2020 were:

Take classes to keep inspired and motivated.

Maintain a community of artist friends.

Deliberate Practice - planned activities to practice specific skills: drawing figures in motion.

Bookbinding: making all of my watercolor sketchbooks

Progress: During January and February I sketched with the Urban Sketchers and went to Art Exhibits at a Gallery, Met, and Morgan with friends to sketch. Then on March 1st a traveler returned to NYC with Covid-19, and the following day a lawyer from Westchester County, who worked in Manhattan, was diagnosed. There was no travel history, thus suggesting the community spread of the virus. My husband and I decided to stay at home and each of us only left the apt to take a neighborhood walk daily.  On March 20th our governor issued a "Stay at Home Order," and in NYC it lasted until June 8th. I amused myself with lots of reading and continued to practice drawing figures in motion (from photos). As a retired physician my reading included lots of coronavirus information - usually press releases because it was too soon to reach the journals.   

I was still drawing figures after breakfast for my sketchbook and in May I began to sketch figures to illustrate a little bit of Covid-19 science and posted them on my blog. In July I’d learned enough about our pandemic to give a virtual lecture on Covid-19 to women in the STEM program at my undergraduate womens college, including mRNA vaccine development. It was this project that gave shape and meaning to my days at home. I posted collages and Covid information on my blog and in the NYC Urban Sketchers and Everyday Matters Facebook pages.                                                                

My major Goal was to remain home, stay healthy, and figure out how to amuse myself. Anything else that I did evolved over the full 10 months since March 1st.

1. Read exactly 80 books, mostly fiction, and many old classics.

2. Posted 67 collages with figures with a little SARS-CoV-2 science for each.

3. Walked in my neighborhood at sunrise since June 8th, drawing anything of interest - the first ones were painted, the rest are pen and ink only like my Gnome.

4. Made watercolor sketchbooks and almost filled 4 that each have 48 pages.  The collages are also in the sketchbooks.

5. Zoomed with grandchildren, art friends, and lifelong friends from other cities - some with standing weekly virtual "visits."

6. Followed FDA and CDC meetings online to gather information about Covid-19, vaccines, and threatments.

7. Watched streaming cultural events and series with my husband in the evenings.

8. Started a weekly virtual ballet barre class with my regular teacher from STEPS.

9. Learned how to make tight fitting 2-3 layer cotton masks for family.

10. Made 12 Coronavirus Christmas ornaments for our family - transferring a watercolor painting to fabric which I then used for a 3 layer ornament.

My Goals for 2021: Get my vaccine with Group 1b and remain healthy. I’m convinced that the rest of the time will be filled with things that will evolve naturally and that I can’t even imagine now.

 

December 30, 2020

SARS-CoV-2 Mutations: Experts Weigh In

SARS-CoV-2 is an RNA virus and these viruses can mutate every time they divide.  If you isolated the virus copies from an individual infected cell, the group of virus copies might all be slightly different based on the mutations that have occurred.  The RNA pictured in my cell drawing has 30,000 building blocks and any one can change, which affects the amino acid it makes for proteins.  Some mutations increase transmission and/or severity, others do nothing, and still other mutations decrease transmission and/or severity.  

These viruses have spike proteins over their surface, and there is a binding region on the spike that attaches to a receptor on our cells and allows the virus to enter the cell and multiply.  Mutations in the spike protein part of the virus are more likely to have an effect on the disease, but it takes many animal and laboratory studies on the virus to determine the effect of dominant variants before any conclusions about the infections can be verified.  Read Below

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Dr. Racaniello, Professor and Virologist at Columbia  University, is concerned that the UK variant is being hyped by the  media  and the epidemiologic data from population studies can't be used to accurately predict biologic changes in the infection.  He says "I do agree we should look into these things but until we have some data we should be careful about what we say."  In studies done on the coronaviruses that cause the common cold it took up to 5 years before they were significantly changed by mutations. 

Several days ago Dr. Fauci said they are trying to get samples of the mutant variant from the UK so they can study it at NIH.  And now a young man in Colorado (with no travel history) has been found.  At this time there is no data that should make us worry about the two vaccines.  They postulate that the mutations affect transmission, but there is no data that suggests that the infection is more severe.  Dr. Osterholm, epidemiologist at the Univ of MN, said on his weekly podcast that if there ever is a mutation that blocks the vaccine,  the mRNA vaccine can be altered in as little as several months.  The collective advice from these scientists is to stay calm, wait for conclusive lab studies to be done, and get vaccinated whenever you can.

 

 

December 26, 2020

HAPPY HOLIDAYS 2020

We had a very quiet Christmas.  Since the pandemic first began we limited our time out of the apartment and have only seen our NYC children and grandchildren for limited times - on the sidewalk in front of our apartment, on socially distanced blankets on the grass in Central Park twice, or when they drive past to leave or pickup items.  ZOOM to the rescue!

We do have a Christmas Tree and enjoyed two full days reading and listening to classical Christmas music in the living room. next to the tree.  It was a change from our pandemic reading/TV room so it was special.  I'm posting a photo of the tree, with ornaments I made over almost 4 decades.  And I included a close-up photo of the ornament I made for this year.  I made 12 - and everyone in the family has one or will have one. 

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This ornament was made from my watercolor painting.  I cropped and sized it so I could fit 4 images onto a plastic backed 8.5 x 11" sheet of fabric which I then printed in our ink jet printer. I used 3 sheets for the 12 images and then used regular sewn techniques to make each one.  Our oldest son ran across town yesterday to pick up 8 for his and his sister's family when the rain stopped.

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Wishing everyone a Happy New Year and a healthy 2021. 

December 23, 2020

The CDC Votes on a Vaccine Distribution Plan

Happy News for some of us.  CDC met this past weekend in order to establish guidelines for vaccine distribution among people in the United States.  The National Academies of Sciences, Engineering, and Medicine developed some guidelines for distribution last Fall.  The Advisory Committee on Immunization Practices (ACIP), an unrelated committee of scientists and public health experts that advises the CDC then met regularly to further refine the distribution based in part on the risk of severe infections and deaths of people in these groups. Phase 1a includes Health Care Workers and staff and patients in Long Term Care Facilities.  Both of these groups just began vaccinations under the guidance of the their states. 

Last weekend the committee met to finalize their recommendations for the next Phase of vaccinations.  Their decisions were based on which groups had the next highest risk of serious infections and deaths. After extensive discussions among committee members, and an open session in which other speakers were able to present their opinions, the committee approved Phases 1b and 1c. These are recommendations for the jurisdictions (states/territories) to set up programs for vaccinations.  We are very happy with the guidelines adopted.   See Below 

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Phase 1b

People 75 years and older and non-health care essential workers (approximately 49 million people).

Phase 1c

People between 65 and 74 years of age and people 16-64 years with comorbidities, and essential workers not covered in Phase 1b: first responders (fireman, police, corrections officers, food and agriculture workers, US Postal Service workers, manufacturing workers (like those making medications) grocery store workers, public transit workers and those who work in education and child care. 

My husband and I are happy that we moved up in the vaccination schedule.  We are in the high risk >75 years group and we have severely limited our activities and contacts since the pandemic began.  Once vaccinated we will still wear masks and follow all of the public health recommendations, but at least we have something to look forward to - in person visits with our children and grandchildren. 

https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm?s_cid=mm695152e2_w 

 

Shirley Parker Levine
New York City

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