October 15, 2021
Since Monday, ADPH has reported 4,562 new Covid cases in Alabama, 11% fewer than the 5,132 cases reported for the same period last week. That is a significantly slower rate of decline than we’ve seen in several weeks. Today, in fact, ADPH reported slightly more new cases (1,143) than it did last Friday (1,049) - the first time that has happened in over a month. This slowdown is somewhat concerning because it suggests we could be starting to plateau. A plateau at the current range of 900-1,000 new cases per day would quadruple our daily average last June, raising the stakes if a new deadly variant were to arise.
Of course, it’s important not to overreact to the data from one day or even one week. To be clear, the Covid situation in Alabama is getting better and hospitalizations continue to be a bright spot. As of today, 716 confirmed Covid patients were reported in 103 hospitals (6.95 per hospital), the lowest level since July 23. Still, it was mid-October of last year, after plateauing at 900-1,000 per day for several weeks, when cases began their relentless climb to the crisis levels we saw in December and January. In the shadow of October baseball, please forgive me for being reminded of Yogi Berra’s famous quote, “It’s like deja vu all over again”.
Then again, 2021 is different because of the availability of life-saving vaccines. This week, an FDA advisory panel recommended booster shots for both the Moderna and J&J vaccines. In the case of Moderna, the panel recommended a half-dose, at least 6 months after the second full dose, for people aged 65+, as well as younger people with certain underlying medical conditions or at increased risk because of occupational or institutional setting. In the case of J&J, the panel recommended a second dose at least 2 months after the initial dose, for all people 18 years or older. The next step for both boosters is for the CDC to receive the panel’s recommendations and make a final decision, which is expected next week.
For now, federal regulators only plan to endorse giving people boosters from the same manufacturer as their initial shots, though the FDA panel expects to review preliminary data on so-called “mix-and-match” boosting. Nevertheless, some members of the advisory panel are already on record as favoring "heterologous" boosting and there are lots of anecdotal reports, especially in Europe, of such mix-and-match boosting.
It also should be noted that the CDC is on record as endorsing mixed mRNA vaccines “in exceptional circumstances”, such as when “the vaccine given for the first dose cannot be determined or is no longer available”. Meanwhile, two European trials -- one in Spain and one in England -- found a stronger antibody response when an AstraZeneca (AZ) shot is followed by one of the mRNA vaccines. (Chancellor Angela Merkel famously received one shot of AZ followed by a 2nd shot of Moderna).The J&J and AZ vaccines rely on the same mechanism, an adenovirus vector, to induce immunities.
In other news, U.S. travel restrictions finally will be lifted on November 8 for fully vaccinated international visitors, including those from more than two dozen nations who have been barred from entering the country since the start of the pandemic. Under the new policy, foreign travelers must show proof of both vaccination and a recent negative coronavirus test before boarding a flight. For reasons I cannot explain, those traveling by land do not have to provide a negative test.
Finally, a word about long-haul Covid, which has been grossly underreported. A study published Wednesday in the Journal of the American Medical Association found that more than half of all people infected with Covid experience at least one long-haul symptom fully 6 months or more after their initial diagnosis, a rate that has the potential to “overwhelm existing health care capacity,” according to the study. The most common long-haul symptoms are wide ranging, including chest imaging abnormalities, difficulty concentrating, generalized anxiety disorder, functional impairments and fatigue or muscle weakness. Issues with the heart, digestive system, and ear, nose, and throat are also frequently reported. The totals:
10/2 - 1,480
10/3 - 892
10/4 - 736
10/5 - 1,549
10/6 - 1,272
10/7 - 1,262
10/8 - 1,049
10/9 - 919
10/10 - 653
10/11 - 467
10/12 -1,353
10/13 -1,016
10/14 -1,050
10/15 -1,143