An update from our Chief Medical Officer:

A couple weeks following Labor Day and predictably the case counts across the country are rising, primarily in the Midwest but in 33 states total. We know that social engagement and close contact without masks greatly increase transmission risk and another holiday spike is sad but not surprising. More unfortunate is the rising death count with US deaths now exceeding 200,000.

But, these optimistic graphics and comments come from Dr. Erik Summers, Wake Forest CMO.

 

We have stemmed surges before and need to continue following the established recommendations for physical distancing, masks and hand/cough hygiene particularly as Autumn has officially begun, the weather is changing, and we spend more time indoors together. New research indicates 40% of health care workers and 20% of general population testing C-19 positive exhibit no symptoms, so we cannot let our guard down!! The prospect of a deadly ‘twin-demic’ with patients suffering from both Influenza and COVID-19 this winter is very concerning to public health authorities and has influenced our own QualDerm Partners policies.

We have implemented an Influenza Vaccine policy that requires all QDP teammates to be immunized for flu in order to protect our staff as well as our patients and communities. QualDerm is acquiring these immunizations and will distribute them at no cost to all employees. Flu vaccines are well established as safe and effective, although the specific efficacy is always dependent upon some estimation about the various strains seen in Southern Hemispheres prior to their arrival in US; their virulence in causing disease; how they mutate over time; and how well they can be matched for the United States. Since never perfectly matched to the common strains, one can still catch the flu when vaccinated but the infection is less severe and immunization protects 70-90% of healthy adults and children. Immunity tends to accumulate over time so more frequent vaccination improves one’s overall resistance and response.

This novel C-19 Coronavirus has not been mutating significantly and experts predict a very good match for new C-19 vaccines, which continue to be developed by multiple manufacturers. Johnson & Johnson began final stages of a clinical trial for the first vaccine that may require only a single dose. But, no vaccines are likely to be available until late 2020 and will be prioritized for vulnerable populations and health care workers first. The general population will probably not have access until early to mid 2021. Most vaccines will likely require two shots at a one month interval. For all vaccines, immunizations generally reduce the severity of an infection, even if not completely preventing it and experts believe this will be the case for COVID-19 vaccines. It may also require annual re-vaccination like with Influenza or until the US reaches herd immunity (approximately 70% of population infected or immunized). This is another reason that vaccination is so important so as a country we can move our economy beyond this pandemic as soon as possible.

Regarding concerns about the safety of new Covid-19 vaccines, regulators have drafted guidelines that would require any SARS-CoV-2 vaccine to meet rigorous standards to gain speedy clearance, according to people familiar with the matter, an effort to ensure shots work safely before they are widely distributed. Furthermore, the FDA is expected to spell out a tough, new standard for an emergency authorization of a coronavirus vaccine as soon as this week. The FDA is releasing “the guidance to boost transparency and public trust as it approaches the momentous decision of whether a prospective vaccine is safe and effective.”

An editorial this week in JAMA Dermatology by the Editor in Chief Dr Kanade Shinkai outlines “Dermatology and COVID-19” and I include it here for providers and anyone interested in the current state of the specialty in regards to our care of pandemic patients.

• In other news, CDC reversed its earlier guidance and now recommends testing for asymptomatic close contacts
• Death rates are declining as doctors and hospitals better understand the virus and transmission, supplies are sufficient, medications and treatments have proven effective in mitigating the severity (steroids, antibody-based therapy, anticoagulants, etc)
• Flu season in Southern Hemispheres is much less intense this year, likely due to Covid precautions and sanitation measures, which hopefully will translate to North America
• US production is increasing for cheap, fast and more accurate C-19 tests

There remains much to be optimistic about and we all just need to continue being vigilant and compliant with the well-established safety measures, especially as we move indoors. Dr. Redfield, CDC Director, stated this week that with universal masking across the US, we could control the pandemic in 2-3 months. Let’s all keep doing our part, individually and collectively!!

Stay well,

John Albertini, MD