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About our “The COVID-19 Crisis” series
The Delta wave of the COVID-19 pandemic continues to abate in the U.S. We are down to about 62,000 new cases a day, and “only” 52,000 people hospitalized. Deaths, too, are going down. However, the virus remains a problem in a few northern states, including Alaska, Wisconsin and Maine, which still have hospital capacity problems due to COVID-19 cases. Meanwhile, transmission rates and hospitalizations are dramatically better in much of the south.
Source: CDC, October 28, 2021
Although 90% of U.S. counties continue to see 50 or more cases per 100,000 residents per week, vaccination rates continue to climb, so we should expect substantially lower risk in the weeks ahead.
On October 29, the Food and Drug Administration (FDA) approved the Pfizer BioNTech vaccine for children between five and 11 years old three days after an advisory committee voted 17 to 0 (with a single abstention) to recommend authorization. Next up, the CDC will likely recommend this vaccine for children in that age group this week. the CDC will likely recommend this vaccine for children in that age group this week. Phase three trials showed the vaccine was 91% effective at preventing symptomatic infections. The pediatric vaccine will be one-third the dose of that given to adults and children over 12 years old.
When reviewing the vaccine, the FDA carefully considered the risk of myocarditis in children from five to 11 years old, and the data showed that the number of cases of myocarditis from vaccines were likely to be lower than the number of cases of myocarditis from COVID-19 infections in all realistic scenarios. In fact, the FDA found no cases of myocarditis in children ages five to 11 in the trial, although the study sample was small (3,000 children). Among children 12 to 17 years old, myocarditis associated with the vaccine is usually mild and limited and thus far has resulted in a full recovery, whereas myocarditis associated with COVID-19 infection is more likely to cause long-term harm.
About 6.3 million children have had COVID-19 so far, and there were almost 118,000 cases in the week that ended on October 21. The CDC reported 657 deaths in those under 18 years old in the U.S.
Younger children generally have mild cases, but are at risk of developing a rare condition called Multisystem Inflammatory Syndrome, a serious condition that can damage the heart and other organs. Also, children are not immune to developing long COVID-19, which can result in fatigue and difficulty concentrating for months or years among other possible symptoms.
My daughter, a pediatrician in Boston, has a five-year-old son and will sign him up for a vaccine the first day that it’s available. She’s eager for her almost-three-year-old to be eligible to be vaccinated too.
The CDC expanded the list of those eligible for COVID-19 boosters to include adults with mood disorders (usually depression, bipolar disease, or seasonal affective disorders). That’s good, because those with mood disorders are statistically significantly more likely to be hospitalized or die from COVID-19 than those without mood disorders. According to JAMA Psychiatry, those with mood disorders are over 30% more likely to be hospitalized with COVID-19 and more than 50% more likely to die of the disease.
At this point, boosters are recommended for:
I got my booster shot last week, and most of my physician friends have already had their boosters too.
Nature published a study showing that if people were starting a new job, a vaccine requirement would be more likely to lead to vaccination than a statement that vaccines are preferred but a personal choice, or a statement that those vaccinated would have more freedom and flexibility. This study asked for the intention to get a hypothetical vaccine, not specifically a COVID-19 vaccine.
The researchers administered standardized tests to identify subjects who had the largest amount of “psychological reactance,” the desire to recapture any lost freedom. Even among this group, vaccine mandates led to higher rates of vaccine acceptance than the other two strategies. This matches real world experience so far and is reassuring. A vaccine mandate is not likely to lead to lower vaccination rates even in a workforce where some loudly oppose vaccination.
From the authors: “All in all, our results suggest that fears about a mandate backfiring may be unfounded and support vaccine mandates as a strategy for achieving herd immunity for COVID-19 in the United States.”
Lancet Global Health published research showing that fluvoxamine, a generic antidepressant in the same class as Prozac, decreased the likelihood of hospitalization or death by about a third in a well-designed, randomized, double blind trial in Brazil. There were about 1,500 participants in the trial; average age was 50 years old and all had at least one risk factor for complications from COVID-19. This follows an earlier study which suggested a benefit but was too small to be statistically significant.
Unlike molnupiravir, the promising antiviral from Merck awaiting FDA emergency use authorization, fluvoxamine is inexpensive and is likely safe during pregnancy and in women of childbearing age. The mechanism for how fluvoxamine provides protection from COVID-19 is not clear, but is thought to have an anti-inflammatory effect and potentially reduce cytokine production.
However, this is just a single study, so we should be cautious and continue to scrutinize the impact of its use in the “real world,” where sometimes even drugs that look promising in well-designed trials are far less effective than we would have hoped. This study evaluated treatment of COVID-19 that was recently diagnosed in people with elevated risk; there is no evidence that taking fluvoxamine regularly lowers the risk of COVID-19 infections, hospitalizations or deaths.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
