08/01/2022
Happy New Year Mountain Communities! I hope everyone in our amazing mountain towns had a fantastic Christmas and a wonderful New Year holiday. I personally am really enjoying the snow that has FINALLY arrived. While I would have liked to wait just a little bit longer before updating our "COVID status" a lot is happening, and I thought it might be worthwhile to review. This is going to be another ridiculously long post, but certainly there is some good news. Let's say - some bad, some good, and unfortunately somethings that in my opinion are truly ugly. Here we go -
Here are the numbers for the week ending 1/7
As I am sure you all have heard COVID cases are increasing significantly across the country with the new omicron variant leading to record spikes in infection rates in multiple states.
Colorado is no exception and our 2-week incident rate for new infections has more than tripled, to 1702.1/100K, by far the highest we have seen through this entire pandemic. Keep in mind what this number really means. In the last 2 weeks, the total number of people in our state that reported a positive COVID test was a little bit less than 2 people (1.7) out of every hundred. Our new average positive test rate over the past 7 days is a staggering 26.77%, and we have 1,374 people currently hospitalized with COVID in the state.
Overall, our state hospitalization rate currently is very similar to where we were last month, despite several weeks now of dramatically increasing cases in the community. This is very strong evidence that the COVID vaccine works to help keep the most vulnerable from becoming seriously ill, and it also lends support to the idea that the omicron variant is far less serious. As is typical, we are again seeing “scary” reports in the media about increasing rates of childhood hospitalizations. I have included the breakdown graph of all hospitalizations in Colorado by age so that you can see the very low actual percentages for yourself. As we have reviewed previously, research out of Stanford University suggests that more than 45% of all pediatric patients who are hospitalized WITH COVID, are NOT hospitalized BECAUSE of COVID, but instead these are children who happened to test positive while they were being admitted to the hospital for a completely different reason. Unquestionably that is even more true now, and even Anthony Fauci felt obligated to remind the mainstream media of this fact earlier this week. https://publications.aap.org/hospitalpediatrics/article-abstract/11/8/e159/179743/Adjudicating-Reasons-for-Hospitalization-Reveals?redirectedFrom=fulltext
Rates in Jefferson County are also increasing significantly and as of 1/6 our 7-day incident rate has quadrupled in the last month to 1013.2/100,000. The county positive test rate is now 24.8%. Fortunately, our 14-day rolling hospitalization rate has dropped nicely to 1.21/100,000 people, and I am thankful that we are keeping people safe from serious illness. I have included a graph of the local cases and hospitalization rates below so you can see these trends for yourself.
Here in our community rates are also increasing as expected - Aspen Park (15.01/1000) has had 15 new cases, while Indian Hills (9.2/1000) has had 13 in the previous 2 weeks. Kittredge has had 15 new cases for a rate of 15.0/1000 and Evergreen increased to a rate 17.4/1000, with a new high of 150 new cases. Genesee is now at a rate of 11.2/1000 with 42 new cases in the past 2 weeks. Rates for Conifer and the surrounding "unincorporated" mountain areas are at 12.9 new cases per thousand in the past two weeks, or 1.29 new cases per every hundred people, which is slightly less than the average rate in the state.
So, what should we expect moving forward? Certainly cases in Colorado are going to continue to increase, hopefully however hospitalization rates will quickly stabilize, and then start to diminish. South Africa’s robust public health surveillance and their willingness to share what they have learned has allowed experts to quickly adjust and current predictions are that states such as New York and Florida that first saw the omicron variant in this country could reach their peak case rates by the end of next week. Colorado should not be far behind, possibly peaking before the end of January or early in February, allowing all of us to celebrate a great Valentine's Day as cases really begin to fall.
As the case numbers grow, it’s worth remembering that we all have had coronavirus infections in the past. This is not 2020. Not only do we have vaccines that are very effective at preventing severe infection, we also have multiple effective ways to treat anyone who does ultimately end up feeling poorly. I might be annoyed, but overall I am not too worried if I just get a cold that can be treated. Recent research from the Canadian Public Health Authorities reports that the omicron variant is 65% less likely to lead to hospitalization, and 83% less likely to need intensive care even for people who are NOT vaccinated. So, as always, be smart about your individual risk, but don’t be afraid to live your life. https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-epi-enhanced-estimates-omicron-severity-study.pdf?sc_lang=en
That leads us to one last topic to buckle up for – booster shots for kids. In the past I have recommended that both the elderly and anyone who is at high risk get a COVID booster shot. I STRONGLY believe that this is the right medical choice, even if this newer variant is less severe. For someone high risk, getting a booster shot could be what keeps you out of the hospital, and that is key to getting through all of this COVID craziness. I feel very differently about my healthy teenagers. Unless what we know in the research were to change significantly I would never consider giving my child a 3rd dose of this vaccine. I am happy to explain to people individually why I feel that way, both with what I see as the potential risks and benefits but it won’t change the fact that in the end - this is just my personal decision. Lots of smart people will and have looked at this same data and made different decisions based on their personal feelings and their own individual risks. There is no “one size fits all” answers in medicine. These are nuanced and individual choices that we all need to make for ourselves and our children.
A bit of important background – vaccines in the US are approved using 2 different required pathways, one through the CDC and one through the FDA. These organizations are run by politically appointed directors, but those directors are advised by independent committees of experts from across the country. The FDA director is advised by what is known as the VRBPAC, and they met on September 17th to review, among other things the idea of giving booster vaccines to 16- and 17-year-olds. Hours of research was presented. In the end, they voted overwhelmingly 16-2 AGAINST giving these booster shots. https://www.fda.gov/media/152597/download Here’s the ugly: the FDA took their advice, waited 2 months, and then just approved the booster shots anyway, no new discussion needed. Worse yet, when it came time to discuss potential booster shots for children between 12-15 years old – the FDA simply didn’t bother to ask the committee of experts for their opinion. WOW. Frankly - I am disgusted and I am certainly not alone. I have added a link to a recent WSJ article that reviews some of these concerns. https://www.wsj.com/articles/dangerous-push-to-give-boosters-to-teens-vacccine-covid-19-omicron-vaxx-requirement-mandate-11640107759 Furthermore, here is a link to the letter written to the Journal Lancet by the 2 lead FDA advisors that have now both quit after decades of service because they are tired of feeling forced to approve the politically “popular” choice instead of making what they feel is the scientifically and medically sound decision.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02046-8/fulltext
In case you thought the CDC would act differently in any way, I am sad to say – No. In what can only be considered a completely unprecedented decision, when the CDC advisory committee (the ACIP) voted AGAINST (9-6) the initial booster vaccines for certain young adults that Rochelle Walensky was hoping for – She just ignored their vote and did what she wanted to do anyway. Medicine and politics are indeed a dangerous mix.
While I can’t possibly review for you all of evidence here – I do want to point out three recent studies that you may find helpful as you make these decisions. YMMV. First is a very recent and high-quality study from Germany, a country with over 13.7 million people who are under the age of 18 that looked of deaths from COVID in children between the ages of 5-11. After reviewing ALL of the data, through out the entire pandemic, for the entire country they found ZERO deaths in healthy children in this age range, and only 4 deaths in kids between 5 and 11 years of age who had significant medical concerns. This should be reassuring news to parents everywhere. https://www.medrxiv.org/content/10.1101/2021.11.30.21267048v1 When approving the Pfizer vaccine for kids between 5-11 group the FDA estimated the vaccine would cause 58 cases of myocarditis for every million doses given, and as recent CDC confirmed VAERS reports would suggest – we are again seeing this vaccine complication in these young children. It’s simply too early to know how common this rare but significant concern might be. Fortunately, this does seem to be a much lower rate of myocarditis than the rate reported recently in the NEJM for boys and men between the ages of 15-25 which was 1 case of myocarditis for approximately every 7,600 teens given a 2nd dose of the COVID vaccine, more than 85% of these young men were hospitalized for this, and there was at least one death. https://www.nejm.org/doi/full/10.1056/NEJMoa2109730. The second study to review is also from the NEJM, using data from Israel that looked at outcomes for people five months after their second Pfizer vaccine, both those who had a booster shot at 5 months and those who didn’t. https://www.nejm.org/doi/full/10.1056/NEJMoa2115926 What they found in the non-booster group for people aged 16-29 was 22,441 cases of infection of which only 10(ten) were serious, and ZERO people died. The booster shot absolutely did reduce the number of cases, but it certainly did not seem to be necessary to keep people safe from severe infection in that young age range. This last study is from the UK health security, that reported that 10 weeks after the Pfizer booster shot protection against the omicron variant dropped from ~70% to just 45%. While I am sure those who have had a booster shot remain very well protected against severe illness which is important if you are high risk, at some point it does seem fair to question the value of repeating a vaccine that seems to be so short lived. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043807/technical-briefing-33.pdf
That’s all – If you actually made it to the end. Congratulations! If not, no worries – I will catch you next time. I wish you all nothing but the best. Until then - Be Safe. Be Kind. And if you need us – Call.
