NHF’s Dr. Leonard Valentino Talks COVID-19, Vacccinations and Gratitude

Life during the time of COVID-19

Can you describe your life during the pandemic … in only six words? Well, a group of students were asked to complete this task. A Houston student said “Close with family, far from friends” while a student in Utah summarized life with these six words “Don’t cough. It scares people now.” My favorite however is “Wake up, get on Zoom, repeat.” Read the entire article here.

SARS-CoV-2 infection (COVID-19) continues to take a toll on people globally. The World Health Organization reports 247.5 million cumulative cases and 5.01 million deaths worldwide as of November 3. According to the World Health Organization, vaccine inequity is costing lives every day, and continues to place everyone at risk. For every 100 people in high-income countries such as the United States (US), 133 doses of COVID-19 vaccine have been administered, while in low-income countries, only 4 doses per 100 people have been administered. What is needed to defeat this global public health crisis is a coordinated action with equitable access to public health resources including access to vaccinations to prevent infection with COVID-19. It is true that vaccines are important to preventing infections, they’re not the only tool that can be used. Testing is needed to know where the virus is, treatments including dexamethasone and medical oxygen are needed to save lives, and public health measures are needed to prevent transmission. The world’s twenty most powerful leaders, the G20, met in Rome at the end of October to discuss many important issues including the COVID-19 pandemic. The World Health Organization told the G20 leaders that they have the power and responsibility to help stem the pandemic by expanding access to vaccines and other tools for the people and places where these are in shortest supply. This occurred in the context of more variants  — the World Health Organizations has defined four variants of concern (alpha [B.1.1.7], beta [B.1.351], gamma [P.1], and delta [B.1.617.2 and AY]), as well as five variants of interest (eta [B.1.525], iota [B.1.526], kappa [B.1.617.1], lambda [C.37], and mu [B.1.621]). The “B.1.621” or “Mu” variant of COVID-19 appears to have been eradicated in the U.S. according to the most recent data. Despite this, the current and emerging variants need to be assessed for their potential for increased transmission rate, pathogenicity, and resistance to immune responses.

Vaccination update

We often think that the vaccine is only protecting the person who receives it but new data from Scotland suggests that the risk of coronavirus infections is also reduced among members of their households. Researchers studied 144,525 health care workers and 194,362 of their household members to determine the rate of infections among the household members. Cases of Covid-19 were less common among household members of vaccinated health care workers during the period beginning 14 days after the first dose (5.93 infections per 100 person-years) than during the unvaccinated period before the first dose (9.40 cases) and after the health care worker’s second dose, the rate in household members was even lower (2.98 cases). Here, the evidence suggests that vaccination may reduce transmission and protect your loved ones as well as you. More data will be needed to confirm this observation.

On Friday, October 29, 2021, the US Food and Drug Administration authorized the Pfizer-BioNTech Covid-19 vaccine for children ages 5 to 11. The decision will allow about 28 million children in the US to be vaccinated against the coronavirus. The timing is particularly important with the flu season starting and major holidays coming soon. You may ask why is this so important? Recent data from the US Centers for Disease Control and Prevention (CDC) showed children ages 5-11 are “at least as likely” as adults to contract the virus, and that hospitalization rates are three times higher among children of color than among white children. Once the CDC Advisory Panel and CDC Director Rochelle Walensky endorse the vaccine, children may be able to receive vaccinations as early as November 3.

For our children

The vaccine became available for 5- to 11-year-olds starting in November. The vaccine is administered in two doses taken three weeks apart. Each dose is 1/3 of the adult dose. For adolescents 12 to 17 years old the vaccine is already authorized, and more than 11 million adolescents have already been vaccinated with the two dose series also given three weeks apart. For any questions regarding dosing or if the vaccine is right for your child, please contact your HTC or primary care physician.

Clinical trials have demonstrated that the vaccine is safe and effective in 5 to 11 year old children. There were no severe cases of COVID-19 infection during the clinical trials. The vaccines appear to work against the delta variant as well as other known variants of concern. Side effects experienced were mild to moderate including fever, fatigue, headache, chills, diarrhea, and muscle and joint pain. Inflammation of the heart which has been linked to mRNA vaccines is very rare. In fact, it’s more frequent after COVID-19 infection than following vaccination. This was also the case in the clinical trials in children.

You may ask, why should I get my child vaccinated? As of October 21st, over 6 million children were infected with the virus causing COVID-19 and over 24,000 children were hospitalized and importantly, 30% of those hospitalized had no underlying medical conditions. COVID-19 is a top ten cause of death for children in the US and moreover, 7-8% of kids experience long COVID-19.

Well, what about us, the adults who were vaccinated earlier in 2021? Are we still protected? Data from Israel, which used the Pfizer–BioNTech BNT162b2 vaccine suggests that among persons 60 years of age or older, the rate of infection in the July 11–31 period was 60% higher among persons who became fully vaccinated in January 2021 (when they were first eligible) than among those fully vaccinated 2 months later, in March. Similarly, for persons 40 to 59 years of age, the rate of infection among those fully vaccinated in February (when they were first eligible), as compared with 2 months later, in April was 70% greater. Likewise, for persons 16 to 39 years of age, the rate of infection among those fully vaccinated in March (when they were first eligible), as compared with 2 months later, in May, was 60% greater. Most importantly, the likelihood of serious disease was 80% higher for those vaccinated earlier than those who waited for the vaccinations. Bottom line here is that the immunity following the Pfizer–BioNTech BNT162b2 vaccine wains with time and booster doses are a good idea.

Could an antidepressant, Fluvoxamine, (Luvox®) a selective serotonin reuptake inhibitor that is used for conditions such as depression and obsessive–compulsive disorder be a key to reducing the severity of COVID-19 infections? According to a recent report, the drug may reduce the risk of getting seriously ill with COVID-19 and thereby decreasing the likelihood of requiring hospitalization. Research published in the esteemed medical journal, The Lancet Global Health enrolled high-risk, symptomatic Brazilian adults with confirmed SARS-CoV-2 infection with a known risk factor for progression to severe disease. There were 741 patients were allocated to fluvoxamine and 756 to placebo group. The average age of participants was 50 years (range 18–102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a tertiary care hospital due to COVID-19 was lower for those who received fluvoxamine group compared with those who received a placebo treatment This observation may be due to fluvoxamine’s effect to depress immune responses and minimize tissue damage. More research is needed to confirm these results.

Gratitude

In this season of thanks, I, on behalf of the entire NHF staff and community, want to thank you for your continued support. Because of you, NHF is closer than ever before to bridging research gaps, increasing community support, and furthering education. The passion you have as providers does not go unnoticed – in fact, it is palpable and inspiring each day. Thank you for being a part of NHF’s journey.

I will close my comments with a shout out to Dana Francis, a social worker who supported people with bleeding disorders and their family members for several decades at the HTC in San Francisco. Dana received the NHF Jill Solomon Social Worker of the Year Award in 1996, and again this past year at BDC 2021. NHF wishes Dana well upon his retirement as he will be missed by the many he helped over his career.

Sincerely,
Dr. Leonard A. Valentino
CEO and President, National Hemophilia Foundation

Source: National Hemophilia Foundation