Santa Barbara Doctors December 2020 Newsletter
December 2020 ExtraCare Newsletter
Well, we made it! The final month of this unforgettable year. With the vaccine now closer than ever it’s time to settle down and enjoy the holiday season. This month we report on the neurological complications of COVID-19 as well as share with you the latest on the COVID-19 vaccine and planned distribution in Santa Barbara.
Please take note of our holiday schedule below:
The offices will be closed at noon on Dec 24 and all day Dec 25. In addition, we will be closed at noon on December 31 and all day
Jan 1.
Dr. Hrach will be out of the office Dec 21-25 with Dr. Viglione available for emergencies during that time.
Dr. Viglione will be out of the office Dec 28-Jan1 with Dr. Hrach available for emergencies during that time.
Dr. Hrach cell number 805-705-5929
Dr. Viglione cell number 805-708-9788
Neurologic complications of COVID-19
The single patient that our practice has lost to this deadly COVID-19 pandemic was a sweet 95 year old woman from Santa Ynez. She was exposed to COVID-19 through a household family member and initially only had symptoms of diarrhea, low grade fever and fatigue. She was hospitalized a week later with mild shortness of breath and cough, requiring oxygen for a short while, but quickly recovered. What ultimately caused her demise was the encephalopathy that ensued. She became confused, weak, incontinent and stopped eating. Rather than die alone in the hospital, her family chose to take her home on hospice where she died a week later.
This sad story underscores the importance of the often under recognized neurological complications from COVID-19 . A recent study published in Neurology Clinical Practice reviewed the medical records of 74 adults (mean age, 64 years) who were hospitalized with COVID-19 and evaluated for neurologic conditions at Boston Medical Center. The most common COVID-19 symptoms on arrival to the hospital were cough (39%), shortness of breath (36%), and fever (34%). Eleven patients required intubation (15%) and 28 required some form of supplemental oxygen (38%). Thirty-four patients required intensive care (46%).
The most common neurologic COVID-19 symptoms at presentation were altered mental status (53%), muscle aches (24%), fatigue (24%), and headache (18%). After neurologic assessment, the most common final neurologic diagnosis was toxic-metabolic encephalopathy (35%), followed by seizure (20%), ischemic stroke (20%), primary movement disorder (9%), peripheral neuropathy (8%), and hemorrhagic stroke (4%).
Three patients (4%) suffered traumatic brain injuries from falling in their homes after developing COVID-19.
Ten (14%) patients died in the hospital. Survivors had “moderately severe” disability at discharge and many were discharged to nursing facilities or rehabilitation hospitals.
There are likely several different mechanisms by which COVID-19 can cause neurologic complications.
These include:
- Stimulation of the body’s immunological response, which causes an autoimmune disorder affecting the nervous system.
- Inflammation of blood vessels, or cells lining the vessels, which ultimately causes release of toxins into the brain.
- Severe systemic illness which causes insufficient oxygenation of the brain resulting in brain injury.
- Increased tendency to form blood clots leading to strokes.
- Worsening of preexisting neurologic disorders.
- Infection of the nervous system by the virus itself.
Many of my patients who have contracted COVID-19 infection report varying degrees of “brain fog” associated with the illness. Symptoms include memory loss, confusion, difficulty focusing, dizziness and fatigue. Most patients recover from these symptoms quickly but some patients report prolonged symptoms that in some cases have led to disability.
We are just beginning to understanding the myriad of complications associated with the SARS-CoV-2 virus. I urge you to please remain vigilant by protecting yourselves for the next few months until a safe, effective vaccine becomes available to all.
The Covid-19 Vaccination: A Community Outreach
It’s with tremendous excitement that the medical community welcomes its first shipment of the Covid-19 Pfizer vaccination this week. As a result, many forecast a steady shift in momentum, and for the first time in nearly 9 months, leverage over a virus that has undoubtedly changed all of our lives. These vaccinations, both the Pfizer and Moderna, are exceptional. The media can cloud the true accomplishment here, but what is indisputable is that both of these vaccines hold tremendous efficacy at an estimated 95%. What this means from a population health standpoint is that 9 out 10 people will avoid infection despite a shockingly high intrinsic viral infectivity. Immune system priming is the core of preventative medicine and resource utilization; by allowing our bodies a better opportunity to fight the infection, we can use our own resources to cease spread to vital organs. In addition to the innate immune system, this includes targeted antibodies and T-cells evolutionarily designed to seek and destroy viruses, quickly. Ventilators, steroids, and re-purposed medications will become second-line therapies as needed, rather than hail-mary solutions with too high stakes. The next steps will unravel quickly, and at Santa Barbara Doctors we promise to inform our patients every step of the way. These 5 major bullets define what we know now:
1. 1900 doses of the Pfizer vaccine will arrive in Santa Barbara this week! A 2nd shipment of Moderna vaccines is expected to be delivered in 1-2 weeks. The vaccination protocol will begin immediately with health care workers (Phase 1a) in order of their exposure risk (4 Tiers). They will be contacted directly by SBCH Employee Health & Safety Clinic who will oversee on-site vaccination. Phase 1b will extend to the residents of long-term care facilities and those deemed to be highest risk of developing severe illness. This is expected to take place between December and April with centralization at SBCH and designated public health sites for close monitoring. Phase 2 will continue vaccination to those of lesser vulnerability and the general community, with expected initiation in April. A coordinated network of local sites, including SBCH urgent care centers, Sansum clinic, county health centers, SNFs, and UCSB will facilitate distribution for Phase 2, with further specifics to be determined by local supply. Routine vaccination is thereafter defined as Phase 3, and this will include local pharmacies and physician practices.
2. The Pfizer and Moderna vaccinations are 2-dose mRNA-based vaccinations, while a 3rd 2-dose vaccination from Oxford University/AstraZeneca is an adenovirus “vector” vaccination. The first two deliver messenger-RNA to the cells to “teach them” to construct the covid-19 spike protein, which is then recognized by our immune system. The latter vaccination simply delivers the spike protein to our immune system. Despite what may be portrayed on social media or numerous blog posts, NONE of these vaccinations permanently alter DNA or genetically modify cells. Early data of the AstraZeneca vaccine suggests [serendipitously] that low dose, followed by standard dose, yielded a comparable efficacy to the mRNA based options above.
3. The Pfizer vaccination has passed FDA emergency use authorization, and the Moderna vaccination is expected to receive approval this week; all 3 vaccines have successfully completed Phase 3 clinical trials. They are not experimental. Immediate safety data is extremely reassuring, but as with everything, certain adverse responses are possible and are important to understand: Of those that received the vaccine, 52-59% reported side effects, and of those, 98% were minor and resolved within 1-2 days. The most common complaints were injection site discomfort (akin to a tetanus shot), fatigue, headaches, and fever. All of these indicate an immune system escalation, and although uncomfortable, are signs that the vaccine is working. More significant side effects of severe fatigue and headache were reported at 3.8% and 2%, respectively. The American College of Allergy, Asthma, and Immunology (ACAAI) released guidelines for safe administration in the setting of known allergies: Those with known anaphylaxis to polyethylene glycol, a component of the vaccine, should avoid the Covid-19 vaccine. Those with common allergies to medications, foods, inhalants, latex, or insects are no more likely than the general public to experience an allergic reaction, but an observation period of 30 minutes is built in, with a trained health care provider to intervene, if needed. It’s unclear if patients with a weakened immune system, or those on chemotherapy, will benefit substantially from the vaccine, but experts, including Dr. Fauci, vehemently affirm that those at highest risk SHOULD be vaccinated. None of these are live-virus vaccinations, which means that they absolutely cannot cause a covid-19 infection.
4. All 3 vaccinations reduce symptomatic infection but have NOT been proven to prevent asymptomatic transmission. This is a powerful statement that illustrates the necessity for large scale vaccination: If a vaccinated person holds detectable viral particle, and he/she is perfectly well and avoids illness, droplet transmission can still occur to an unvaccinated individual and propagate disease. Please do get the vaccination! And come to us with any questions or concerns.
5. Social distancing and masks will unfortunately not go away in the near future, but vaccination is a critical step to stop the morbidity of this disease while herd immunity safety takes effect. These vaccinations require 2 doses separated by at least 3 weeks. Beyond this, it generally takes at least 3 weeks to develop sufficient antibodies to provide protection. The duration of these antibodies is still being elucidated, and many anticipate repeat vaccination series yearly to adequately maintain immunity. This is ultimately a small price to pay to keep our colleagues on the front line, our loved ones, and our community, safe.
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