Global Health Division at Mount Sinai Morningside ED

02/21/2022

Dr. Paul Farmer was a hero of the global health community and a. model human being, helping to lead the charge against AIDS, TB and more. He also helped found Partners In Health and inspired so many young people to enter the field of global health. Paul and I had corresponded for years, and then I met him first in Rwanda in 2007 (this photo shows him meeting my win-a-trip winners, Will Okun and Leana Wen, that year in Rwanda). So it's devastating to hear that he died overnight. The world has lost a huge advocate for the world's poor. RIP, Paul, and thank you for all you have done.

05/30/2021

https://www.nytimes.com/2021/05/30/world/middleeast/syria-displaced-camps-nahla.html?referringSource=articleShare

Nahla al-Othman lived in a tent camp for displaced Syrians where her father often chained her to stop her from wandering. She was malnourished and choked to death while eating too quickly.

05/16/2021

https://www.npr.org/sections/goatsandsoda/2021/05/13/996488271/what-is-black-fungus-and-why-is-it-spreading-among-indias-covid-patients?utm_source=npr_newsletter&utm_medium=email&utm_content=20210513&utm_term=5384703&utm_campaign=goats-and-soda&utm_id=195886&orgid=397&utm_att1=goatsandsoda

Doctors say India's battle with COVID-19 has led to an unprecedented rise in mucormycosis, a rare but dangerous fungal infection that preys on people with weakened immune systems.

05/14/2021

https://www.nytimes.com/2021/05/12/business/economy/covid-seychelles-sinopharm.html?referringSource=articleShare

Seychelles has seen a surge in coronavirus cases even though much of its population was inoculated with China’s Sinopharm vaccine.

04/25/2021

https://www.nytimes.com/2021/04/24/world/asia/india-coronavirus-deaths.html?referringSource=articleShare

Fatalities have been overlooked or downplayed, understating the human toll of the country’s outbreak, which accounts for nearly half of all new cases in a global surge.

04/24/2021

Understanding how different the new variants of the coronavirus are from the initial cases of COVID-19 is critical to addressing the current phase of the pandemic

04/24/2021

Early trials show Oxford developers may have finally found an effective jab against the disease.

04/08/2021

https://www.nytimes.com/2021/04/06/us/politics/vaccine-passports-coronavirus.html?smid=fb-share&fbclid=IwAR3Aeiu7s2nvpKyLhbT6atdnZGA7XYlxAqT1vO1VOrjOAtogD_h3rGz11rw

Businesses and universities want fast, easy ways to see if students and customers are vaccinated, but conservative politicians have turned “vaccine passports” into a cultural flash point.

04/08/2021

Myanmar’s security forces have killed more than 40 children since February. Here is the story of one, Aye Myat Thu. She was 10.

03/30/2021

Long COVID is one of the least understood parts of the pandemic.

Scientific studies have estimated between 10-30% have long COVID19, especially among those initially hospitalized for the disease (studies are here, here, and here). But there are two really important, unanswered questions:

1. If you already have long COVID, does the vaccine help reduce symptoms? Many with long COVID are, understandably, nervous to get the vaccine. Answering this would help ease minds.
2. Do people with initial asymptomatic infection get long COVID? This would help explain the risk to vaccinated and even maybe the risk to kids.

Short answer: We just don’t know yet.
Long answer: Coming in hot…

**Why does long COVID happen?**
In order to answer these questions, we have to know why long COVID happens. There are at least three hypotheses circulating:

1. Some people harbor the virus in an organ, which would be missed by nasal swab. So, people continue to have long COVID symptoms.
2. Viral pieces stick around in the body causing symptoms for a long time.
3. COVID causes the body to start attacking itself (autoimmune type disease).

**If you already have long COVID-19, does the vaccine help reduce symptoms?**
A recent study found that vaccines don’t make long COVID symptoms worse. And, actually, ~30% of people with long COVID19 reported getting better with a vaccine (~20% said symptoms got worse; 50% said symptoms stayed the same).

Why? We think the vaccine is helping the immune system in one of two ways:
1. The vaccine clears some of these reservoirs in the organs and essentially eliminates the cause of the problem.
2. The vaccine reprograms the autoreactive cells. Basically, the vaccine tells the cells that are attacking to stop.
Is this temporary relief? Maybe. Is it a combination of #1 and #2? Likely. An immunologist (Dr. Akiko Iwasaki) recently said on NPR: “The fact that not everybody's feeling better after the vaccine indicate that there may be multiple reasons why people are suffering from long COVID.”

**Do people with initial asymptomatic infection get long COVID?**
Vaccinated people can still harbor the virus (in the nasal passageway) if they come in contact with it. A circulating hypothesis is that vaccinated people are less likely to have a higher viral load. So, they’re less likely to get the disease (and transmit the disease). And, then, are less likely to get long COVID19.

We’ve seen in preliminary research that the worse the initial disease (i.e. more than 5 symptoms in first week of COVID), the more likely chance of long COVID.

However, a new preprint study is the first to disprove this hypothesis.

Preface: I’m a little hesitant to talk about this study because it’s a preprint and I have a few methodological concerns. I hope the peer review process picks up on a few of these. But, this study is circulating mass media and people, understandably, have questions.

This study utilized a large sample of medical records in California (178,971 people). Scientists selected medical records of people never hospitalized with COVID and were asympomtatic for the first 11 days (1,407 people). What did they find?
-27% of those reporting symptoms at day 61+ were initially asymptomatic
-Symptom experience among those who become long-haulers changes over time
-Long-COVID (defined as having symptoms for more than 61 days) was evenly distributed across age. In other words, any asymptomatic person, regardless of age, can get long COVID
-Women were more likely to have long COVID than men

As the authors state, we desperately need more research on long COVID. And this is coming. The NIH has set this as a priority and launched a massive long COVID study. Unfortunately, like everything else in this pandemic, we are at the mercy of time.

Love, YLE

For the data sources and figures, see my newsletter here: https://yourlocalepidemiologist.substack.com/p/long-covid-vaccines-impact-and-prevalence

03/09/2021

As I’m sure you’ve seen by now, CDC published their guidelines for vaccinated people. Here are my thoughts…

1. “Indoor visits between fully vaccinated people who do not wear masks or physically distance from one another are likely low risk.”
Not surprising. We know vaccines protect the vaccinated. Time to keep moving.

2. “Unvaccinated people (…) can visit with fully vaccinated people indoors, without anyone wearing masks, with a low risk of SARS-CoV-2 transmission.”
So, if you’re vaccinated you can be unmasked around an unvaccinated, low-risk family member. I’m surprised (and happy) about this recommendation. I’m surprised because the CDC doesn’t like risk. They are incredibly careful (sometimes too careful). Even if someone is low risk, that doesn’t necessarily mean there is NO risk; they can still end up in the hospital from COVID19. So, to me, this is an indication of two things:
A. CDC is confident that vaccinated transmission is really low. We do have preliminary evidence, but nothing concrete yet. Maybe they have some secret insider information; and/or,
B. The CDC is confident with the science and their list of high risk diseases.
Nonetheless, this is great news.

3. “If any of the unvaccinated people or their household members are at increased risk of severe COVID-19, all attendees should take precautions”
You need to be careful if you’re vaccinated and visiting an unvaccinated older adult, pregnant friend, or someone with medical conditions (listed HERE). Period. We have 523,850 deaths in the United States that can “prove” COVID19 is not friendly to some. This particular guidance will also help keep hospitals above water.

4. “If unvaccinated people come from multiple households, there is a higher risk of SARS-CoV-2 transmission among them. Therefore, all people involved should take precautions”
This highlights two things. First, individual risk between two unvaccinated people from two households is high. This is not surprising. Epidemiologists have been shouting this from rooftops for a year now.

Second, this hints at population risk. The vaccinated person can still transmit the virus (even if it’s at a lower rate) to all unvaccinated in a room. The vaccinated person can still do serious damage to multiple households at a time. So, in this case, everyone needs to still be careful when we start mixing households.

5. “All people, regardless of vaccination status, should avoid medium- or large-sized in-person gatherings and to follow any applicable local guidance restricting the size of gatherings.”
Again, this highlights individual risk (among unvaccinated) and population risk (among vaccinated). Fine. No concerts yet. I have tickets from a postponed 2020 concert that’s rescheduled for November 2021. I’m hopeful this will still happen.

6. “At this time, CDC is not updating our travel recommendations and requirements.” Which is: “Delay travel and stay home to protect yourself and others from COVID-19.”
This was surprising to me and made me grumpy. But after sleeping on it, I think I understand why CDC decided this. If you’re vaccinated, there is very little individual risk while traveling. The problem comes when we start talking about populations moving. The more people travel (especially from a high risk area to a low risk area), the more you threaten low risk areas. Vaccinated people put populations at risk when they travel. This also tells me that the CDC is still very much worried about variant spread.

Bottom line:
-CDC took a safe and cautious route, as per usual. This guidance did not to take any risks (except for one small one).
-Can vaccinated grandparents hug healthy grandkids? YES. YES. YES.
-There’s an undertone that vaccines significantly reduce transmission
-We still do have quite a few questions that need to be answered. For example, do vaccines reduce chances or severity of long COVID19? It will be months (if not years) before we have a clear understanding of this. Proceed with caution.

Love, YLE

P.S. CDC’s guidance doesn’t change anything about my infographs; the implications of those scenarios are still accurate.

For data sources and pictures, see my newsletter here: https://yourlocalepidemiologist.substack.com/p/cdc-guidelines-re-vaccinated