As I’m sure most of you are aware, Covid-19 cases have risen dramatically over the last few weeks in both the United States and Europe. Thankfully, in California and the Bay Area, we have been fairly insulated from the bulk of this increase.
Over the last two weeks, however, new cases have been climbing in both Santa Clara and San Mateo Counties. We have not yet seen an increase in hospitalization rates at our closest hospitals, Stanford, El Camino, and Sequoia. I feel that in our immediate area, we are still in somewhat of a bubble. This is likely the result of the majority of our community practicing social distancing and consistent mask wearing. Most new cases are still felt to arise from indoor gatherings of people who are having dinners, celebrating events, or working closely with others without masking.
Both Pfizer and Moderna have announced efficacy of their mRNA vaccines. Both vaccines are being studied in placebo controlled phase 3 trials, and involve 30-45 thousand people. In Pfizer’s study, there were 94 Covid-19 cases in their interim analysis. 90% of these cases were in the group who got placebo. In Moderna’s trial, they had 95 cases, with 90 of them in the placebo group, and 5 in the vaccine group. There were 11 cases that were severe, all in the group who got placebo.
These are highly encouraging results.The challenge with be in production and distribution, as mRNA vaccines need to be transported frozen, in order to maintain efficacy.
Johnson and Johnson and AstraZeneca are in trials with their adenovirus based vaccines. Stanford is participating in the J & J trial and we’ve had a couple of patients participate. Stanford’s vaccine uses an adenovirus that can’t replicate that delivers the DNA of the Covid-19 spike protein to a person’s cells to then express it, and cause an immune response. There are no data out yet on the efficacy of these vaccines.
We are still at least a couple of months out, if not more, from the potential distribution of a vaccine. We are doing our best to have vaccines available here in our clinic as soon as they are available, and we are in frequent communication with our contacts and distributors.
We are still able to do PCR based nasal swab Covid-19 testing in our office. We send our samples to either Stanford or Quest. Turnaround times have generally been 1-2 days, although this may be longer around major holidays. We’re looking at further options for rapid testing and home based tests, and are happy to advise you of those options.
We are very pleased that Dr. David Hiroshima has joined our group. He offers his advice on family gatherings with the upcoming holidays.As much of the country endures a third wave of Covid-19 infections, we want to give you our recommendations on staying healthy during the upcoming holidays. Some of you may have already decided to stay home and celebrate virtually, or with your immediate household only. This is certainly the safest option. Hosting, or attending a gathering this year will require some creativity and vigilance to keep everyone healthy. Here are some ideas to consider.
1. Consider hosting your event outside. Outdoor gatherings carry much lower risk than indoor gatherings. Consider something like a backyard luncheon or a picnic in the park. If an outdoor event is not possible, you can consider doing an indoor event, but keep in mind that adequate ventilation is very important. Homes are not designed to have the same rapid air exchange (4-6 times per hour) that commercial spaces have. By opening all of the windows in the home, and even turning on the exhaust units in the kitchen and bathroom, you can increase your air exchange from once per hour to roughly 2-3 times per hour.
2. Keep the invitation list short. We know that this may be difficult, especially if you’re used to a larger, more boisterous gathering. Last Friday, California’s top health officials issued their guidance on Thanksgiving get togethers. These guidelines included not gathering with more than two other households. People who are at high risk of severe disease should not attend. Consider having all guests limit their social contact for one week prior to the gathering.
3. Maintain social distancing practices during the event. We know that it may be hard to resist hugging or shaking hands with your favorite people. While it’s natural to let our guard down around the people we love, we need to keep our vigilance up for everyone’s sake. Wear masks when not eating or drinking. Wash hands frequently and use paper towels for drying and have hand sanitizer stations available. Avoid buffets and shared plates and beverages, and instead try to create individual portions in order to minimize the shared use of items.
We hope that everyone is able to find a way to still enjoy this time of year and enjoy a connection to their families and loved ones. There are several things that we can all do keep each other safe, and we recommend that you keep up your level of caution during the holidays.
Happy Thanksgiving from all of us at Peninsula Doctor!
Ian Kroes MD
David Hiroshima MD