COVID-19

COVID Updates from UCSF (Diana Lau, PhD, RN, CNS) 

Dear friends and colleagues,

We will discuss the coronavirus mutations that have taken major stage in the news this past weekend and the implication of Winter Solstice celebrations. Thanks to the >200 attendees who joined us in our 10th bilingual CoVID-19 Town Hall last week. We will try to answer the questions here that we did not get to in the town hall. 

Mutation  

Despite advice from health experts and lockdowns imposed in many U.S. cities mandating people to stay home and not make non-essential travels, U.S. airports have collectively recorded over 1 million travelers passing through security checkpoints on Friday and Saturday alone!

Then came the scary news from the U.K. that there was a new variant of the SARS-CoV-2 identified which was found to be spreading ~70% faster than before. This variant was also found in Denmark, the Netherlands, Italy, and Australia. Fortunately, European health experts in Europe and elsewhere gave reassurance that this SARS-CoV-2 variant mutant does not diminish potency of the vaccines under development. Read more here.

This mutation could infect Americans, just like infecting people in other countries, which have imposed restrictions to not allow stopping of flights from the U.K. But public health officials in the U.S. have decided not to be too alarmed, as mutations of viruses are nothing new. The new variant now spiking in the U.K. has been identified since September/October. The SARS-CoV-2 actually is more stable and apparently does not mutate as fast as the flu virus. Obviously, there is much more to be discovered and to learn about mutations and other aspects of the Novel Coronavirus!

Winter Solstice 冬至 12/21/2020  

Forgetting that the Winter Solstice is today, I have received many ecards during the past weekend, both here and from afar, reminding me of festival – one that some Chinese around the world regard as even more important than the Lunar New Year. The Winter Solstice Day is celebrated with big family dinner gatherings traditionally – sitting closely together at a table for hours eating, drinking, talking loudly, and enjoying each others’ companies. These are usually happy and heart-warming events. But this year under the threat of the pandemic, it could turn disastrous if particular attention is not paid to how the events are held. Using common serving utensils, doing a buffet-style meal using individual plates, eating at least 6 feet apart, ensuring good airflow, and try to put the masks back on immediately when not eating/drinking – all help to decrease the virus transmission. The better thing to do would be not to hold big dinner gatherings this year.

Dr. Peter Chin-Hong and George Rutherford, UCSF experts in infectious diseases and epidemiology, advised during the Town Hall that we should save the big celebrations for next year, and we all need to really double down on our public health measures to wear masks, keep the minimally 6 feet physical distance, and do not plan holiday parties.

Answers to the Questions from the 12-15-2020 Town Hall regarding the SARS-CoV-2 Vaccines  

1.      Will we get to choose which of the two vaccines we get or will it depend on where we get it or when we get it? if we do get to choose, which one is better/should we ask for?
Individual institutions that give vaccinations may make that decision as more brands of vaccines become available. As of now, only two vaccines have been approved (Pfizer and Moderna),  and it is not clear that all vaccination sites could receive both vaccines.
2.      For the vaccine shot, do you recommend taking the same brand of the vaccine since we need 2 doses?

For vaccines that need two dosings, using the same brand of vaccine should be used. Some vaccines in the development only require one injection.

3.      How will we be notified that it’s our turn to get a vaccine?

The CDC provides general guidance to vaccination allocation priorities. Each county then decides on its own vaccine allocation and communication plans. Staff who work in healthcare or skilled nursing facilities would be notified by their own institutions. The rest should pay attention to local news, social media, announcements from the Department of Public Health, the City’s Emergency Response Department and hospitals, as well as communications from your physicians via mails, emails, or your electronic medical records. All these may be part of the possible venues to find out vaccination information.

At UCSF, the Human Resources Department just posted the vaccination plan online for managers to share with employees.

Stay tuned as we will also notify you of each phase of vaccination in this email listserv. Anyone who wishes to sign up for this listserv can send an email to ahi@ucsf.edu and put in the subject line: “Add email to listserv”.

Right now, we only have a very limited supply of vaccines in the San Francisco and Bay Areas, so only the critical core of clinical/auxiliary staff who work directly with CoVID-19 patients in the Emergency Room or Critical Care Units could get vaccinations.

(Stanford residents staged a protest in front of the hospital during the weekend for not being included in the first Phase of vaccination, despite that they stayed onsite to take care of patients infected with CoVID-19 in the ER and ICUs. Stanford stated it would make adjustment to its priority plan. )

4.      Does each person need two-dose of vaccine to get the 94.8% protection?

Yes. The first dose provides only ~50% protection by the Pfizer/BioNTech vaccine. Two doses increase the protection to 94.5%.

5.      Two-dose: How many days apart?

The second dose should be taken at least 21 days and up to 28 days after the first dose, using the same brand of vaccine.

6.       How many days (after the 2nd shot) to ensure protection?

The body takes up to a few weeks after the first dose, and at least 7 days after the second dose, to build immunity after vaccination.

7.       How long will the 94.8% protection last?

At this time, experts do not know how long someone is protected from getting COVID-19 after taking the SARS-CoV-2 vaccine. It is almost certain that the immune response initially generated will wane over time. We don’t yet know the lowest amount of immunity that needs to be retained in the body to protect against infection, nor what type of immunity provides this protection.

8.     Do we need to vaccinate every year? I mean to get two shots every year.

Very likely that annual vaccination will be needed for a couple of years at least, or more. Depending on the brand of the vaccine.  Both Pfizer and the Moderna vaccines require two shots.

9.    I know the vaccine is very effective at 95%. But still does that mean you have a 1/20 chance of still getting sick even with the vaccine if exposed?

Yes. But data from clinical trials suggest that even if one were to unfortunately still get infections after vaccination, the infection is less serious.

10.   What is considered to be severe infections?

A severe infection usually requires hospitalization and may involve the use of supplemental oxygen and/or ventilators. However, there is a condition called “silent hypoxia”, in which patients may have a severe infection, but feel pretty well despite the falling blood oxygen saturation levels. That is why we advise all infected patients to use a pulse oximeter at home for monitoring. A falling or <95% blood oxygen saturation level is an indication to call your physician and go to the hospital as directed.

11.   Do you have the updated ethnic breakdown for CoVID-19 cases and deaths?

The local County and State’s Department of Public Health provide the CoVID-19 data on newly confirmed cases as well as deaths from CoVID-19. Many of them have data reported for the race/ethnicities categories. For San Francisco, you can see those data here.

12.   Are Asians still leading in % deaths though not for cases, and why?

Yes, in the San Francisco County, but not statewide. Most of the deaths came from people >65 y.o. and have one or more serious medical conditions. ¾ of deaths in the skilled nursing facilities in San Francisco were comprised of Asians. Disaggregation of race into the Asian sub-groups and an investigation into the death cases in skilled nursing facilities may yield more information.

13.   Could Bay Area ICU capacity be taken over/filled by out of region patients causing beds to be unavailable when local patients need it? What guidance/rules are there in place to preserve ICU capacity for locals?

The state mandates that each County in California should retain a 15% bed vacancy rate in the Intensive Care Units to stay ready for patients infected with CoVID-19. Each individual hospital, along with the county, makes the decision on accepting patients outside of the county in a manner that should not impact care of the local patients.

14.   Friends will travel to So Cal for X’mas. What precautions should they take will they return to SF?

The whole state of CA is now exploding with CoVID-19 infections, and the Stay-at-home order has been issued to all Bay Area Counties. There is a 10-day quarantine period for any travel out of the 9 Bay Area counties. We need to cancel non-essential travel plans during the holiday. Taking care of ourselves by staying home and wearing masks, and canceling parties and gatherings are a few of the sacrifices that we can make to keep the big picture of the pandemic in control this Holiday Season. It is a small sacrifice that could save lives, including our own. So, we hope that we would all try our best to restrain ourselves from the traditional holiday traveling and celebrations this year.

15.   After vaccination, can one still be able to transmit the virus to others?

Yes. One still needs to wear facial masks and keep the 6 feet minimal social distance after vaccination, until about 70% or more of the population has been vaccinated.

16.   Do people who got COVID-19 build antibodies already? If so, do they still need the vaccine?

Yes. They do, the natural immunity from being infected with SARS-CoV-2 usually lasts at least 3 months. But the antibodies produced decrease overtime. Individuals should take the vaccine after the antibodies are no longer detectable in the body to get protection.

17.   Do we need to vaccinate every year? I mean to get two shots every year?

Very likely that annual vaccination will be needed for a couple of years at least, or more. The number of injections depend on the brand of the vaccine.  Both Pfizer and the Moderna vaccines require two injections.

18.   If I have the side-effect from vaccine, is the side effect permanent or I can recover from it?

The approved vaccines are quite safe, as they have gone through at least a 6-weeks waiting period after vaccination – during that time most of the adverse effects would have appeared. The adverse effects have been found to be transient, lasting only for a couple of days, and usually more severe after the second dose. After taking the second dose, the side effects may be severe enough to warrant some people to stay off work for a day or two.

19.   Who would pay for the side effects of serious Bell’s Palsy?

According to the FDA’s briefing document dated Dec. 10 here, Bell’s palsy was reported in four vaccine participants and none in the placebo group, out of the 44,000 total participants of the late-stage vaccine trial ( here ). So, it is quite rare.

But the FDA stated that “the observed frequency of reported Bell’s palsy in the vaccine group is consistent with the expected background rate in the general population, and there is no clear basis upon which to conclude a causal relationship at this time.” Still, the agency recommended surveillance of this condition once the vaccine is distributed into larger populations.

We all should have health insurance to cover payment for medical treatments.

20.   Is there a vaccine for people with allergic conditions?
CDC lists having true known severe allergy as a contraindication to take vaccines.  Read Vaccine Guidelines of the ACIP here. However, many people do not have “true” allergies which involve severe swelling and difficulty breathing. So, it is best to consult with your primary care physician when in doubt.  On the other hand, there have been a couple of allergic reactions in vaccinated people who do not have a history of allergies. To be safe, it would be good to stay around for about 15-30 minutes after vaccination to make sure that there are no allergic reactions before leaving. (Most allergic reactions occur within 15 minutes of vaccination.)
21.   Do we need to pre-register for the vaccine?
When our turns come, we should make an appointment for the vaccination as it involves an injection.

22.  Is it safe for breastfeeding women to get the vaccine?

There is no data on the safety of COVID-19 vaccines in lactating women, or on the effects of mRNA vaccines on the breastfed infant, or on milk production/excretion. Please consult your doctors.

  1. What is the vaccination priority for people with organ transplant?

Theoretical concerns have been raised regarding the potential for triggering rejection with vaccinations. Read Vaccine Guidelines of the ACIP here.

We hope the above helps to address part of your concerns. This is the information we know only as of now. As time goes on, we will know more about the vaccines and can update you as we find out.

Thanks to the media friends who have joined us in the Town Hall and help to disseminate the information. Please click here to read another Chinese article from Singtaousa using information from the Town Hall.

We want you to know that we care about you, and hope that you can build trust with our UCSF team. The benefit outweighs the risk of taking the vaccine by far. So we believe in taking the vaccine when our turn comes. We hope you would too!

Wishing you a wonderful Holiday Season despite the pandemic. Let’s all stay resilient through this difficult time, knowing that all that our suffering will be lifesaving for ourselves for now, and will become history one day soon!

Happy Holidays to everyone,
Diana

Diana Lau, PhD, RN, CNS

Director, Asian Health Institute

1600 Divisadero St., Box 1609

San Francisco, CA 94143-1609

Email: Diana.lau@ucsf.edu

Facebook: www.facebook.com/UCSFAHI

Categories: COVID-19

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