We recently discussed the tragic ascent of the USA death toll from COVID-19 to the previously unimaginable level of 1,000,000. Having this number of our fellow citizens succumb to this virus is a uniquely American FAILURE! None of the largest wealthy countries have a COVID-19 death rate as high as ours. There is a myriad of factors which contribute to this situation. The foundation of our plight is a pre-existing healthcare system that devotes inadequate resources to public health, preventative, and primary care; exhibits grossly inadequate access, and underinvests in long-term care. Parenthetically, although per capita spending is almost twice as much as other wealthy countries (Kaiser Family Foundation), we lag behind other systems in metrics such as life expectancy and infant mortality. Preexisting conditions such as hypertension, diabetes, obesity, and chronic diseases of the lungs, kidneys, heart, etc. contribute to the severity and ultimate outcome of being exposed to this coronavirus. Upon this foundation, we add the initial governmental incompetence by not providing truthful information or timely personal protective equipment. Most importantly elected officials and pundits fueled the mis/disinformation and therefore, politicization of this pandemic. An American ideology has thus developed and continues to prevent too many from accepting vaccination, masking, and social distancing when necessary.
As we are approaching a third consecutive Memorial Day weekend enthralled in this pandemic our country is averaging more than 100,000 COVID-19 cases per day, the highest level since February 2022. This case number in actuality represents an underestimate of the case numbers since there is so much unreported home testing occurring. Hospitalizations have risen 28% in the last two weeks. The good news is that deaths have decreased 15% over the last two weeks. Hamilton County and all of the bordering counties remain at the CDC’s “Low” level of community spread.
This SARS-coV-2 virus continues to proliferate as a quarter of eligible Americans have not been vaccinated. The predicted result is the emergence of new mutations. A new Omicron subvariant, known as BA.2.12.1 has become the dominant strain in the US. It now makes up 58% of the sequenced strains in the country. Currently, there is no evidence that this strain is more severe than the original Omicron. Cases in New York City are surging and driving the fifth wave of COVID-19. Mask wearing in crowded public places is being encouraged but not mandated. On the other hand, there are school and university communities in the northeast and Hawaii which have reimplemented mask mandates.
In order to combat this continuing battle with this virus, getting vaccinated remains the mainstay of management. The vaccines will not prevent disease, but experience shows us that severe disease and death are likely to be prevented. Because of the FDA and CDCs recent recommendations our children between the ages of 5 and 11 are now eligible for a COVID-19 booster. This injection by Pfizer/BioNTech is authorized at least 5 months after the second shot has been shown to increase a child’s immunity, especially against the Omicron variant. The data reveals that childhood cases and hospitalizations are on the rise and yet only 36% of children in this age group have received even their first dose. This new recommendation for a booster for this 5-11 age group adds to the prior recommendation for a booster in children ages 12 to 17. A second booster for all persons aged 65 or older and for those 50 years and older if they have certain preexisting conditions has also been authorized. Pfizer and Moderna’s requests for authorization for a vaccine for children under five is to be considered in early June.
An extremely important update on the vaccination front is that the FDA has restricted the use of the Johnson & Johnson (Janssen) Covid-19 vaccine exclusively to individuals 18 years and older who are not able to get a mRNA vaccination. The agency has decided that the risk of a rare clotting disorder associated with low platelet count outweighs the benefit of the vaccine in that age group. (https://www.fda.gov/media/146304/download).
The virus continues to mutate, we must adapt as information, occurrences, and science changes. We continue to look forward to life after COVID-19, but we are not there yet.
Clyde E. Henderson, MD
Cincinnati Medical Association