Santa Barbara Doctors ExtraCare – March 2021 Newsletter
March 2021 ExtraCare
Newsletter
Spring is in the air, the hills are starting to turn green, the trees are starting to bloom, the birds are nesting and allergy season is kicking in 🙂 It’s hard to believe that we have been living with COVID now for a year but also exciting to see vaccine distribution moving forward. This month we continue to provide helpful links to get you all vaccinated and share with you some promising real-world data regarding the vaccines.
Glimmer of Hope
As Santa Barbara County COVID cases continue to decline and our community begins to reopen it gives us a glimmer of hope that life can indeed return to normal. Lest you feel the need to let your guard down prematurely I thought I would present you with some sobering statistics regarding COVID-19 in the U.S.
We have exceeded 530,000 deaths from COVID-19 in just one year.
COVID-19 is now the third leading cause of death in the U.S., following only heart disease and cancer.
Life expectancy in the U.S. has dropped by one year in part due to COVID-19.
The key to getting back to our pre COVID life relies on the majority of our population getting vaccinated.
California has opened its vaccine distribution on March 15 to people ages 16-64 if they are deemed to be at the very highest risk of getting very sick from COVID-19
EITHER because they have one or more of the following severe health conditions:
Cancer, current with weakened immune system
Chronic kidney disease, stage 4 or above
Chronic pulmonary disease, oxygen dependent
Down syndrome
Solid organ transplant, leading to a weakened immune system
Pregnancy
Sickle cell disease
Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (but not hypertension)
Severe obesity (Body Mass Index ≥ 40 kg/m2)
Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%
OR if, as a result of a developmental or other significant, high-risk disability, one or more of the following criteria applies:
A COVID-19 infection is likely to result in severe life-threatening illness or death; OR
Acquiring COVID-19 will limit the individual’s ability to receive ongoing care or services vital to their well-being and survival; OR
Providing adequate and timely COVID care will be particularly challenging as a result of the individual’s disability.
If you feel that you qualify for vaccine under these circumstances, you are eligible to register for vaccine.
Vaccine remains in short supply in our community. Again, our advice is to try as many sites as possible to improve your chances of getting an appointment. (Helpful hint: It seems that the pharmacies in Ventura have more appointments available)
Here are some helpful links:
Cottage Hospital (Goleta Valley drive through)
https://www.cottagehealth.org/coronavirus-covid-19/
https://asap.pdllabs.com/non-ees/CottageCovidVaccine.aspx
Vons Pharmacy at 1046 Coast Village Rd Suite B, Montecito, CA 93108
Schedule Link: https://kordinator.mhealthcoach.net/vcl/1609885881329
Waitlist Link: https://kordinator.mhealthcoach.net/vcl/1610484349482
Sav-On Pharmacy at 1018 Casitas Pass Rd, Carpinteria, CA 93013
Schedule Link: https://kordinator.mhealthcoach.net/vcl/1609883413244
Waitlist Link: https://kordinator.mhealthcoach.net/vcl/1610483127722
CVS Pharmacy
https://www.cvs.com/immunizations/covid-19-vaccine
Ralph’s Pharmacy
https://www.ralphs.com/rx/covid-vaccine
Walgreens Pharmacy
https://www.walgreens.com/findcare/vaccination/covid-19
Rite Aid Pharmacy
https://www.riteaid.com/covid-19
Re-Visiting Real World Vaccination Stats
With global vaccinations efforts well underway, real world safety and efficacy profiles of these vaccinations yields increased clarity. Real world data with millions of test subjects is now readily available for analysis, and its so important to repeat analysis in however many scenarios needed to best build trust. One such example was highlighted beautifully in the Feb 24 issue of the New England Journal of Medicine (NEJM) when structured data from Israel’s largest health care organization was analyzed to reassess results put forth by the original Pfizer clinical trial.
The Israeli healthcare system offers a prime platform to perform this sort of observational analysis because of its robust data collection and extremely high participant population. It’s admittedly rare to have a health care system which meticulously documents health history, vaccination status, and follow-up data for easy review This study looked characteristics of almost 600,000 vaccinated people and characteristic-matched 600,000 unvaccinated people, which allows unprecedented statistical strength. Table 1 below shows how well both arms were matched to one another, with the major variable being vaccination status:
Estimated vaccine effectiveness after 7 days post vaccination was very consistent with what Phase 3 clinical trials reported in late 2020: 94% efficacy for symptomatic infection following both doses, with 57-66% 2 weeks after the first dose. The original randomized control trial that Pfizer reported had only 10 cases in the severe COVID-19 category, creating a barrier to robust statistical analysis, but this confirmatory study recorded 229 cases, identifying 92% efficacy 7 days after the second dose. Note the significance of figure 2 below: ALL markers, including death due to COVID-19, incidence of severe COVID-19, hospitalizations, and symptomatic COVID-19 show marked differences. What’s striking also, is that the subgroup analysis effectively shows that this trend is carried forward in all time intervals tested, and EVERY subgroup. In other words, protective effects are confirmed at every age, every time interval, and at every health parameter. Men/women, young and old, healthy and unhealthy. The highest levels of protection were, not surprisingly, conferred to those at highest risk of COVID-19 complications, including those with hypertension, diabetes, obesity, and advanced age.
Last month we discussed the emerging COVID-19 variants and the growing concern regarding antibody recognition. This was not well documented in the original Pfizer phase 3 clinical trial because genetic analysis was not consistently completed. Interestingly, days prior to data analysis of this study it was estimated that 80% of the Covid isolates were the B.1.1.7 (UK) variant, and therefore the aforementioned results aggregate effectiveness across multiple strains. The plateau of all ‘cumulative incidence’ curves to the left imply that vaccinated persons respond to this variant. This observation was supported in multiple recent articles that show that mutations in this spike protein still respond to the Pfizer vaccination with high efficacy.
With the advent of electronic medical records and global communication, this is one of many observational studies that we anticipate to be published to provide credence to the phase 3 clinical trials of all 3 active vaccinations. And with millions of people worldwide receiving doses weekly, curation of data over the coming months will yield solutions to even the most complex questions moving forward.
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2101765?articleTools=true
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