Santa Barbara Doctors ExtraCare – February 2021 Newsletter
February 2021 ExtraCare
Newsletter
What a relief to finally begin seeing a downturn in the COVID transmission and hospitalization rates in our county. As front line health care workers, battling this latest surge has been both emotionally and physically exhausting. Add to this the angst surrounding the emergence of new COVID strains and the painfully slow vaccine rollout and I think it is fair to say that we are all ready for it to end.
This month we do our best to help clarify what is known about some of the new COVID variants and help you to navigate through the chaotic vaccine rollout process.
Understanding the Covid-19
Variants
It’s no surprise that a virus with such infectivity has been evolving ways to evade treatment. The Darwinian solution for survival is to mutate and hope for the best. Errors in replication most often inhibit genetic “fitness”, but on occasion, even the most subtle changes in the genetic blueprint have profound effects on how our body recognizes these foreign invaders. What contributes to a viable variant? First, it has to replicate quickly. The higher the rate of replication the higher the chance of an essential error to be made in the genome. Secondly, these variations have to give it a significant advantage to either overwhelm the immune system, or in some cases, overwhelm treatment options. The same principles apply to antibiotic resistance; its an eternal game of cat and mouse, with much higher stakes.
Three strains of covid-19 variants that have emerged as global concern are worth reviewing in the context of current vaccinations:
1. First is the variant (B.1.1.7) known as the UK variant. This strain has 23 mutations all confined to the spike protein that is intricately involved in attachment to the surface of host cells. As of today, 1277 cases have been identified in the US with 186 cases noted in California. Key genetic mutations allow for enhanced infectivity by allowing more efficient docking to target sites. Initial data suggests an increased death rate, but more definitively, enhanced infectivity. Two downstream effects of this make it especially worrisome: 1. Lackadaisical habits that previously worked may furthermore NOT, and therefore these variants may take full advantage of COVID-19 fatigue as it sweeps across the US. 2. Higher infection rates can overwhelm hospitals and claim more deaths by exhausting resources. This is pandemic 101; blitzkrieg the host and take control of the engagement rapidly. The next question on everyone’s mind is: Do the available vaccines protect against this emerging strain? The answer, fortunately, is YES, as recently demonstrated by effective antibody neutralization of the variant as outlined in a recent publication by Dr Muik et al in Science.
(https://science.sciencemag.org/content/early/2021/01/28/science.abg6105)
2. The second variant (B.1.351) is known as the South African variant and is defined by 8 mutations in the spike protein, distinct from the UK variant. As of today, 19 cases have been reported in the US with 2 identified in California. This variant is also deemed to be highly infectious, but as opposed to the UK variant, may partly evade the immunological response rendered from available vaccinations. Preliminary data reported yesterday in the New England Journal of Medicine (NEJM) suggest a 66% “neutralization-titer reduction” in the Pfizer vaccination. In layman terms, this study shows that antibodies developed in response to the Pfizer vaccination were 2/3 less effective in neutralizing the South African variant. Caution should be taken, though, to translate this directly to vaccine efficacy, because the immune response is composed of more than just antibody neutralization; it includes T cells, B cells, natural kill cells and an arsenal of cytokines that are known to play a pivotal role in Covid-19 protection.
(https://www.nejm.org/doi/full/10.1056/NEJMc2102017?query=featured_coronavirus)
3. The third variant (P.1) is known as the Brazil variant. It has 17 mutations, only 3 of which are contained to the spike protein. This variant has not yet been identified in California, but 3 cases have been identified in the US. This variant holds similar concerns to the UK variant because it contains an identical “escape mutation” (E484K) which can allow it to evade the immune response generated not just from vaccination, but also from prior infection. Whereas data suggests that reinfection is uncommon, this may be an emerging issue if the Brazil variant gains momentum in the US. Data on the P.1 variant is admittedly sparse, but both the Moderna and Pfizer vaccinations are expected to provide similar protection as compared to the South African variant discussed above.
A reasonable question on everyone’s mind is SHOULD I get the vaccine if variants continue to emerge? The answer is YES! In the genetic age scientists are able to readily sequence these variants and provide boosters as needed to modify immunity. Moderna is already working on a booster shot to better cover the South African variant as a precaution, but it’s important to remember that even a reduction in protection still yields protection, and that all vaccines protect against progression to severe illness and hospitalization. The power of this cannot be understated in this global battle.
Earlier this week, Santa Barbara County opened its vaccine distribution to include those age 65 and older. They plan to open soon to essential workers including those in emergency services, food, agriculture, education and childcare.
The unfortunate reality is that the supply of vaccine in our county is woefully inadequate to meet the needs of our population and the state is dragging it’s feet in releasing the terms of their rollout proposals moving forward. In addition, our practice was notified by the health department earlier this month that despite being approved by the state to distribute vaccine, we will not be receiving vaccine to distribute to our patients.
The web of vaccine distribution confusion gets even more complicated when you add the federal government distribution sites and retail pharmacies into the mix.
We remain committed to do our best to help our patients get vaccinated, and have compiled a list of resources to help you.
The first step to take is to determine if you are eligible to receive vaccine. This can be done by visiting the states myturn site.
Another site worth bookmarking is the Santa Barbara county public health department site which provides an updated snapshot of who is currently eligible for vaccine.
www.publichealthsbc.org/vaccine/
Once you have determined that you are eligible for vaccine, the next obstacle you have to overcome is to figure out where you can get vaccine.
I have been most impressed with the organization and efficiency of the cottagehealth site and encourage all my eligible patients to sign up on their contact list. This is the drive through vaccine clinic across from Goleta Valley Hospital.
Some of our local Vons and Albertsons’s pharmacies are receiving limited supplies of vaccines and are intermittently opening up appointments as supply arrives. The signups are listed at the site below.
Some CVS and Rite Aid pharmacies are also offering vaccine although to my knowledge none in our area. This may change though, and the following link to CVS is probably worth bookmarking as well.
In addition, several patients have shared with me that they were able to receive vaccine from the UCLA, USC or Sansum Clinic systems by registering through their respective patient portal sites. I have also had patients drive to the state vaccine hub at Dodger Stadium to receive vaccine.
Given the chaotic vaccine rollout to date, our advice is to register with as many sites as you can and check those sites frequently. We will continue to pressure the county health department to send vaccine to our offices but make no guarantee that we will be successful. We promise to update you frequently as we learn of new vaccine availability.
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