All things currently Covid

Epidemiology:

Covid all but disappeared in NJ over the summer and well into the fall.

Then, pts started coming in early November, a lot.

They were not as many sick ones and fewer progressed to intubation, but some still did.

I know not the reasons for its disappearance or reappearance. I supported the former and oppose the latter.

Mask use among these pts and their workplaces was extremely high.

Differences:

We have treated another >50 Covid pts in the last 1.5 months.

The Covid panel, so dubbed by our team, consists of LDH, ferritin and D-dimer.

In several new pts, the pattern of elevated labs appeared different with LDH and ferritin high on admission, but the D-dimer was/is often normal initially and slowly increased later in the admission in the absence of DVT or PE.

We are seeing new infections in pts who had Covid in March or April. We haven't seen any of these second infection cases get very ill, but they have been symptomatic. The time between the two SARS-CoV-2 infections has been in our experience over 6 months.

Antibody+ and Virus+:

Previously, we only tested antibody levels in Covid pts, who hadn't received Convalescent Plasma and were getting better.

From these data, we knew that pts can be both virus positive and have IgG simultaneously, not exactly the most encouraging finding at the time for vaccine development, But these pts were getting better.

Recently, we started testing IgG against SARS-CoV-2 in pts on admission. Several pts are positive for both and sick from Covid.

One pt was sick from Covid as best we could determine, virus(-) x 3 and IgG+.

This pt had the typical Covid chest CT findings and elevated Covid panel (LDH, ferritin and D-dimer) as well as a negative work-up for other respiratory pathogens.

However, he was RT-PCR(-) and IgG(+).

He was hypoxic but improved with treatment.

Yeah, I have no idea what these data are telling us about the pathophysiology of this disease.

Vaccines:

I can't wait.

As of yesterday, 5 vaccines using 3 different approaches reported efficacy rates >70%. AstraZeneca's efficacy was the lowest.

The four approaches are -

1. 2 mRNA nanoparticles (95% & 94.5% efficacy)

2. 2 modified Adenovirus single cycle vectors (70% & 91.4% efficacy), and;

3. Dead virus (86% efficacy).

These data, to me, suggest the antibodies are very protective against infection, despite the observations in disease above. Since dead or inactivated viral vaccines do not induce a strong CMI response, subunit vaccines, which typically induce a stronger humoral response than inactivated, whole virus, should be very effective as well. So far, subjects who received the vaccines and had history of prior Covid infection have done fine. Now, the questions are what's the duration of protection and are there any rare adverse effects.

The discussions in the press and by physicians on the vaccines' safety profiles have been...uneasing. (I know it's not a real word yet, but it should be)

The downside of the press's coverage of vaccines and all things Covid is that many Jersey residents are refusing to receive the vaccine. (For disclosure, I heavily and directly criticized the news show, which I am familiar with personally, for an "expert" spreading misinformation about the vaccines' safety profiles.)

The Swab Mob offered free Covid testing in March through July. In Jersey City, where we went twice, residents would talk to us and tell us, even though we told them they could use a pseudonym, they wouldn't get tested because they were afraid we were part of the government and going to use their DNA (for what, they didn't say). So, we took some hair follicles without them realizing.

SMS