U.S. Vaccinations Monitored in February

The four-part series “Vaccination Nation” concludes today with updates on vaccination rates.

An already botched national COVID-19 vaccine distribution rollout has been hampered by hesitancy, suspicion, and a spate of severe winter weather that ravaged Texas and 23 states in the Southeast, forcing mass vaccination clinics to close.

On the other hand, there are reports of declining infection rates nationwide, while there is evidence of greater mask-wearing. The yin and yang of healthcare continues, with bad news often coupled with encouraging news.

The disturbing trend of vaccine hesitancy, as we have continued to report, prompted ICD10monitor and Talk-Ten-Tuesdays to produce a four-part series, “Vaccination Nation,” and today, Tuesday, Feb. 23, we conclude our reporting on how the U.S. has been grappling with issues associated with vaccinations. In the meantime, we encourage you to listen to the archived versions of the broadcasts. Moreover, we have compiled a list of questions to which Erica Remer, MD, co-host of Talk-Ten-Tuesdays, has responded, along with a potpourri of highlights in the news about COVID-19.

In her own words, here is Remer’s take on what the country has been experiencing:

COVID Variants
Viruses’ job is to replicate. The more contagious a virus is, the faster it can spread. During replication within an organism, viruses have a tendency to sustain mistakes in genetic sequencing. If the mistakes are not favorable, the variant peters out. If the mistakes, or mutations, are advantageous, the virus is more successful at propagating itself, and the variant flourishes. Several COVID variants have been noted recently, in South Africa (B.1.321), the United Kingdom (B.1.1.7), and Brazil (P.1). The nomenclature for the variants is not standardized, which is causing grief; referring to the geographical location can be stigmatizing, and is being discouraged (https://www.nature.com/articles/d41586-021-00105-z).

Now that they are increasing genomic sequencing here in the U.S., we are finding the variants that have been seen worldwide, and unfortunately, we even have generated some of our own domestic mutations. The more circulating virus you have, the more opportunities the virus has to mutate, and the U.S. has had very high levels of positivity this winter. If we reach herd immunity by vaccination and infection, we may be able to thwart more variants from propagating. We are essentially in a race to vaccinate against the Darwinian propensity for the virus to evolve. (https://www.nytimes.com/live/2021/02/14/world/covid-19-coronavirus)

Masks Matter
The Centers for Disease Control and Prevention (CDC) has updated its recommendations on mask use. The recommendations, which can be found online here: (https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html) include:

• Make sure your mask fits snugly against your face (which prevents air from escaping around the mask);
• Choose a mask with a nose wire and adjust it to fit your nose (to prevent air from escaping above, steaming up your glasses, and avoiding slippage);
• You can use a mask fitter or brace. I bought mine from 4Ocean (https://www.4ocean.com/products/4ocean-face-mask-support-frames?variant=37976782405825), a company dedicated to clean water; a pack of four cages supports the removal of one pound of trash from the oceans, rivers, and coastlines;
• Add layers of material – you can wear a cloth mask that has multiple layers of fabric, or wear a disposable mask underneath a cloth mask. The cloth masks I make have a pocket between two layers of material, where I nestle a surgical mask. (The instructions and patterns are here): https://www.craftpassion.com/face-mask-sewing-pattern/#face-mask-patterns;
• Knot and tuck ear loops of surgical masks (you can see a video here: https://www.youtube.com/watch?v=UANi8Cc71A0&feature=youtu.beThis prevents air from escaping from the sides on your cheeks.

Please place disposable masks in the garbage. It is disheartening how many discarded masks litter the parking lot at my supermarket. It is estimated that every month during this pandemic, 200 billion disposable face masks and plastic gloves are being disposed of and impacting the environment.

Consider cutting the strings prior to disposal. There have been numerous reports of wildlife getting caught in strings (https://blog.theanimalrescuesite.greatergood.com/animals-tangled-in-masks/) and domesticated pets swallowing masks, causing bowel obstruction.

Vaccine News
On Feb. 26, the data review of Johnson & Johnson’s single-dose vaccine will be available. The Food and Drug Administration (FDA) will then announce whether it will approve the emergency use authorization (EUA) application. A single-dose regimen with a vaccine that is stable at normal temperatures will likely be a game-changer. As we noted before, the vaccines are in a race with the variants.

There are new recommendations regarding mammograms and COVID-19 vaccination from the Society of Breast Imaging. They are finding axillary lymph node enlargement on the side of the shot after vaccination, and this can confound the interpretation of an imaging study, causing unnecessary follow-up testing. Women are being advised to get their yearly mammogram before their first dose or at least four weeks after the second dose.

The CDC has updated its recommendations regarding COVID-19 exposure in people who are considered fully vaccinated; that is, they have received all shots in a series and are two weeks removed from the final vaccine. These individuals may forego expectant quarantine, assuming they meet all of the criteria:

• Fully vaccinated
• Within three months of receipt of last dose in series
• Have remained asymptomatic since exposure

Therapeutics
There are handful of new investigational drugs being tested to treat COVID-19 through a public-private partnership to coordinate research and speed development of promising treatments and vaccines:

• An inhalable beta interferon delivered by nebulizer;
• A long-acting monoclonal antibody combination that is being studied as both an infusion and an intramuscular injection; and
• An orally administered serine protease inhibitor that may block SARS-CoV-2 from entering cells.

To ensure that the trials are being conducted in a safe manner, there is independent oversight and review of accumulating data. Most therapeutics are tested on people who have confirmed COVID-19 and a risk factor for progression to severe disease. The studies are set up as placebo comparisons. If the new medications are administered to inpatients and new technology ICD-10-PCS codes are developed, you can be sure we at Talk-Ten-Tuesdays will bring that information to you.

Be safe out there. Double-mask, physically distance, don’t congregate, practice good hand hygiene, and get vaccinated.

Programming Note: Listen to Talk Ten Tuesdays today at 10 a.m. EST for the final installment in the four-part series, “Vaccination Nation.”