Latest Health Updates

Frequently Asked Questions
Stay Informed

Fast Facts about Monkeypox 8-9-2022

Until recently, Monkeypox has been a disease associated with residence in or travel to West or Central Africa or contact with infected persons or animals from those areas. Since May 2022 it has been identified in 80+ countries including the US.

Monkeypox can spread by:

  • skin to skin contact with a person with monkeypox
  • contact with clothing, bedding or other objects that are contaminated with the virus
  • respiratory droplets or secretions from the eyes, nose or mouth of a person with monkeypox
  • animals to people and vice versa

Monkeypox symptoms tend to start 5-21 days after exposure and can include:

  • fever, headache, muscle aches, swollen lymph nodes, exhaustion and sometimes cough or sore throat
  • rash, when it is present: 

o   appears in 3-5 days
o   as a single or numerous lesions on one or multiple parts of the body
o   painful or painless
o   progressing from flat to raised to pustules and then scabbed


All of the above images are from https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates


Vesiculopapular rash of monkeypox. Source; Nigerian Centre for Disease Control
Image from http://publichealth.lacounty.gov/acd/docs/MonkeypoxCAHANMAY2022.pdf



http://publichealth.lacounty.gov/eprp/lahan/alerts/CDCMonkeypoxUpdate061422.pdf 

Monkeypox usually resolves without complications in 2-4 weeks. Immunocompromised persons, age <8 years and pregnant or breastfeeding persons may have more severe disease and require treatment with TPOXX/tecovirimat, an antiviral medication.

Monkeypox can look like several other common illnesses including chicken pox, shingles, syphillis and herpes. If you have symptoms and/or rash contact you doctor about testing. If you do not have a doctor, call 211 to be connected to Public Health resources for testing.

If you have Monkeypox you should:

  • wear a high efficiency mask at least through the early symptoms of the illness
  • keep rash covered with clothing
  • do not share clothing, bedding, towels
  • avoid skin to skin contact with people and pets until all scabs have been replaced by new skin

Vaccination with Jynneos vaccine is useful for:

  • post-exposure prophylaxis for persons who have had worrisome contact with suspected or known monkeypox; vaccination in the first days after exposure can prevent illness and vaccination 5-14 days after exposure may reduce the severity of illness
  • pre-exposure prophylaxis for some people known to be at high risk of exposure to monkeypox

Go to http://ph.lacounty.gov/media/monkeypox/  for more information; vaccine eligibility and vaccination sites are expanding frequently.

Ann Walker, MD
PCC Student Health Services Physician

COVID Update 4-28-2022


Student Health Services is available through medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email and phone inquiries during our business hours: Mon-Thu 8a-4:30p & Fri 8a-12:30p.

Oh, the Things You Learn by Doing

        A relative, who is up-to-date with vaccination, had a positive home rapid COVID test this past weekend. This relative is age-eligible for treatment of mild/moderate COVID and had none of the severe symptoms in the L.A. County Isolation Instructions. Outpatient oral and injectable antiviral and monoclonal antibody treatments and an injectable pre-exposure preventive are available depending on certain medical conditions and demographics other than age even for mild/moderate COVID cases. We started going through the proper channels and found that some places are not familiar with the current protocols, some are limited to the medication they can prescribe, not all locations have all the treatments available, and some locations are in the process of getting established but not yet operational.

        What did we learn from my relative’s experience? If you have a new positive COVID test and think you might be eligible for outpatient treatment, there are at least five avenues you could pursue:

  1. Call your primary care physician.
  2. Go to one of the “Test-to-Treat” sites using a high efficiency mask (i.e. double surgical mask, N95, KN95, etc.)
  3. Go to an urgent care clinic using a high efficiency mask.
  4. Set up a virtual or in-person appointment at a pharmacy sponsored clinic (CVS, Walgreens, Rite Aid and others). Use that high efficiency mask if you go in-person.
  5. Call 833-540-0473, 8a-8:30p, 7 days a week to request a free telehealth appointment with the LAC DPH medical provider on call.

        Furthermore, the overall experience has resulted in some take home messages:

  1. Your best protection is still being up-to-date on vaccinations and using masking, distancing and ventilation to avoid exposures. If you are 12-50 years old with certain medical or demographic risks, you are eligible for a 2nd booster; persons 50+ and all persons with 2 doses of J&J are all eligible for a second booster.
  2. Know your risks and which, if any, of the medications for COVID may be right for you.
  3. Get tested if you have symptoms, even if they are mild. If the test you took is a rapid test that was negative, you either need a PCR test or to continue repeating the rapid tests.
  4. If you are testing because you have symptoms, you need to follow isolation instructions.
  5. Be prepared to try multiple avenues to get medication for mild/moderate COVID. If you feel too tired to advocate for yourself, ask a trusted friend to help you but be ready to speak to providers to authorize your friend.
  6. If you are on any prescription or over the counter medications, be sure to discuss them with your prescriber. There are several drugs that are contraindicated with Paxlovid and many more that require caution.
  7. If you are not seen at a site that will hand you the medication you need, use the Test-to-Treat locator to find pharmacies where a prescription can be filled. Call them to confirm they have the medication in stock before showing up with a prescription or having one called in.

Where We Are Now

        As of 4/21/2022, the L.A. County CDC “Community Level” is still low as reported in the L.A. County Post-Surge Dashboard and Strategies. On 4/21/2022, the 7-day total of new cases in L.A. County was 124 per 100,000 persons. This is far, far lower than the peak 7-day total of 3,239 new cases per 100,000 persons in early January 2022. Additionally, the number of new COVID hospital admissions per 100,000 persons and the percentage of staffed hospital beds occupied by COVID patients both remain low. While we know that immunity based on vaccine (or on prior COVID illness) does not always prevent infection when challenged with new COVID variants, pre-existing immunity reduces severe disease and death with the variants we have seen so far and vaccination is the safer choice for building immunity.

        In addition to being mostly de-coupled from hospitalization and death for people with robust immunity, new case numbers are not the primary indicator they used to be before home testing became widespread. L.A. County Public Health has established 8 Early Alert Signals on the Post-Surge Dashboard to monitor with an in-depth review of contributing factors and a consideration of modifying community prevention strategies as any one of these signals moves to medium or high concern.

Thursday Funny

Adapted from https://napavalleyregister.com/opinion/editorial/cartoon-of-the-day/article_2a0239b1-500f-5f79-b813-582a2ecbf1c3.html

Alt Text    A couple has opened a package labeled "Omicron". They read a note that they have been enrolled in the variant of the month club.

Basic Preventive Measures 

  • Being “up-to-date” on vaccinations is your strongest protection
  • Use the very best mask you have when you are with other people
  • Avoid crowds and close contact to reduce your risk
  • Isolate/quarantine when indicated by your local Public Health authority 

Quick Links to Resources 

Ann Walker, MD 
PCC Student Health Services Physician 

Mindy Throop, NP 
PCC Student Health Services Director 

COVID Update 1-13-2022

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 to leave a voicemail. We will respond to email and voicemail inquiries during our business hours: Mon-Thu 8a-4:30p & Fri 8a-12:30p

We have ourselves in the midst of another wave of COVID. While this is discouraging, particularly after all the extra effort we have put in over the past 2 years, it important to note that we are here. We are surviving and together we will get through this. The good news is that we have a lot more information than we did 2 years ago. While science continues to change with new discoveries every day, we are better off than we were in 2020.

What You Need to Know About Masks 

Estimates of time to transmit COVID under different combinations of no mask, cloth, surgical and N95

This table came from the American Conference of Governmental Industrial Hygienists in spring 2021.Based on what we know now about the transmissibility of Omicron, you should cut the exposure times in half. If there are only two people gathering and at least one person has the equivalent of a N95 (even without fit testing) the other can use a surgical mask for a couple of hours. 

The reality of most workplaces and classrooms are that there are multiple people together for 1 to 8 hours. A non-fit tested N95 or the equivalent for everyone is the sensible masking choice. The key features of successful masking are the fit, filtration, and comfort. 

The fit of a mask is largely about preventing leaking around the mask. Instant fogging of glasses is usually a sign of leaking. Sometimes slower, lighter fogging is a function of your exhaled air being warmer than the air outside your mask. 

The filtration refers to the ability of a mask to remove aerosol particles which are very small. A filtration efficiency of 95% means that 95% of the 3 micron aerosols are removed. Particles that are bigger and smaller are excluded at higher rates. 

The comfort of the mask is also key because if the earloops/headbands are too tight or if improving the fit or filtration of the mask makes it too hard to inhale/exhale or makes you too hot, you are not likely to keep that mask on.  

If you are still not convinced, read this article. Follow the link to the YouTube video for the “Mask Nerd” best picks and then follow the link under the video to the google document for the testing Aaron Collins (aka the Mask Nerd) has done since 9/2020. If you have a high-quality mask for each day of the week, you can store them individually in a breathable paper bag and pull them out to use again the following week until they are soiled, have gotten wet or no longer have a good fit. If you have a boatload of 3 ply procedure masks, consider using a brace (“Fix the Mask” is one) to improve the fit. The CDC has a shorter list of non-NIOSH mask ratings.

Remember, there is no guarantee that Omicron will be our last rodeo. We know that COVID is with us now, just like the flu and other viruses that spread every year. We will come out of the pandemic but there will be times that require increased adherence to guidelines and extra precautions. All this means is we will learn to live with it, but appropriate masking when necessary, hygiene, and self-care are principals we should heed!

Changes to Isolation and Quarantine Advice 

The first thing to remember is that isolation is what you do when you have a positive COVID test or have symptoms that suggest COVID illness. Quarantine is what you do when you have had close contact with a known or suspected COVID case but have no symptoms yourself. 

The CDC got the ball rolling on 12/27/2021 with its recommendation to shorten isolation and quarantine for the general public. At this point, there are still differences between the CDC, State of California, County of Los Angeles, and Pasadena recommendations. The generic advice when there are differences in recommendations has been to follow the recommendations of your local Public Health Authority.  

If you are a resident of Pasadena you need to look at the PPHD Health Orders for Isolation and Quarantine. These documents were released on 12/31/2021 and are likely to be changed further.  

If you live in L.A. County but not in Pasadena or Long Beach, use the LAC DPH Isolation and Quarantine Requirements and Recommendations. They are easier to read than the Health Orders and more up to date than the Instruction sheets. 

Definitions to Remember 

      In order to use your local Public Health recommendations for isolation and quarantine, you need to know the difference between “fully vaccinated” and “up-to-date". 

Fully vaccinated means you completed your primary COVID vaccination series 

o   Two doses of Pfizer or Moderna with appropriate timing 

o   One dose of J&J 

o   One additional dose for moderately to severely immunocompromised (Pfizer or Moderna preferred) 

Up-to-date means 

o   You have had the booster dose for which you were eligible, 5 months after full vaccination with Pfizer or Moderna, 2 months after full vaccination with J&J OR 

o   You are fully vaccinated and not yet eligible for a booster 

     For a comprehensive recap of primary vaccination, additional doses, booster doses and how to count international vaccines go here. 

Thursday Not-So-Funny But It Is True

  “Two hospital patients, separated by a curtain. One calls out “Nurse”. The other answers “Yes?”. The healthcare personnel that patients depend on are now often also sick.”

https://pbs.twimg.com/media/FIrCtciXwAAYzRX?format=jpg&name=large

Basic Preventive Measures 

  • Being “up-to-date” on vaccinations is your strongest protection
  • Use the very best mask you have when you are with other people 
  • Avoid crowds and close contact to reduce your risk
  • Isolate/quarantine when indicated by your local Public Health authority 

Quick Links to Resources

  

Mindy Throop, NP 

PCC Student Health Services Director 

Ann Walker, MD 

PCC Student Health Services Physician 

COVID Update 8-18-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and has added some in-person services.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours: Mon/Wed/Thu 8a-4:30p, Tue 8a-7p, & Fri 8a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have two more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on August 24th and 31st. These dates are open to students, staff, families and the community at large.

Looking at the Numbers for L.A. County

        Average daily cases in L.A. County have been rising since early June when they were in the low 100’s. As of 8/17/2021, the 7-day average of daily cases was 3,442 based on the Daily COVID-19 Data Page. Average daily hospitalizations have also risen steadily since mid-July to 1,639 as of 8/17/2021 and the test positivity rate has increased from 0.4% to 4.1% as of 8/17/2021. The case and hospitalization rates continue to be driven primarily by infections in unvaccinated persons.

     In the 8/6/2021 Colleges Telebriefing, Dr. Ferrer noted that counting from the onset of vaccinations:

  • 5.1 million fully vaccinated persons (FVPs) in L.A. County
  • 16,000 of those 5.1 million have tested positive for COVID at any point after being fully vaccinated (0.3% or 3 out of every 1,000 FVPs)
  • 446 of the infected FVPs have been hospitalized (0.09% of all FVPs or about 1 out of every 10,000 FVPs)
  • 41 FVPs have died with COVID infection (0.0008% of FVPs or about 1 out of every 100,000 FVPs)

        Data on breakthrough infections takes time to collect. The quote of 5.1 million FVPs suggests that this data represents breakthrough infections that occurred no later than ~mid-July. Average daily cases have grown significantly since then. We are far better off than we could be without vaccinations; Dr. Ferrer estimates that hospitalizations would be around 6,000 per day as of early August except for the effect of completed vaccinations.

How Delta is Changing Advice for the Fully Vaccinated

        Like the weather in England, if you don’t like what you see in terms of COVID advice for fully vaccinated persons (FVPs), just wait a bit and it will probably change. That is meant as a recognition of rapidly changing conditions rather than a critique of the advice process.

        If you are relying on advice from the CDC or your local Public Health Department, don’t pull out a paper copy of their recommendations that you printed a few weeks ago without also checking online for the intervening updates. Asymptomatic FVPs who are known to have had close contact with a COVID case are now instructed to test at 3-5 days after exposure. That test should be a PCR because antigen tests are not adequately sensitive for asymptomatic people. They are also advised to monitor for symptoms and mask more diligently for the 14 days following close contact though they are not otherwise restricted in their activities if they remain asymptomatic and have negative test results.

        Even FVPs should consider upgrading the quality of their masks, follow an “outdoor first” strategy and minimize other exposures for a week if they plan to visit a relative who is either unvaccinated or at high risk for severe COVID illness. If you are lucky enough to still live in an area of low to moderate transmission, the CDC says you may CHOOSE to wear a mask in public indoor settings but why would you want to wait to find out (and possibly, the hard way) that your area has now migrated to substantial/high transmission? The only way to get COVID down to a manageable level is to reduce transmission. Full vaccination makes the largest contribution to reducing transmission but careful distancing (at least with persons outside our household), effective masking, avoiding crowds and choosing the best possible ventilation represent contributions that everyone can make.

mRNA Vaccine 3rd Doses for the Immunocompromised

        The FDA and the Advisory Committee on Immunization Practices (the ACIP, an independent panel of experts advising the CDC) both recommended that people with moderate to severe immunocompromising conditions who are fully vaccinated with a mRNA vaccine should get a third dose. The CDC estimates that 3% of Americans are moderately to severely immunocompromised. L.A. County Public Health has provided a self-attestation form in English and Spanish for these persons to present when they request a third dose.

        If a self-attestation form makes you feel squishy about people “jumping the line”, remember that requesting medical documentation leads us back into the pitfalls of historically inequitable access to healthcare. It is the same inequitable access to healthcare that means many groups of persons have never had their immunocompromising condition identified.

        People who qualify for a third dose should wait a minimum of 28 days after their second dose. They should also seek the same vaccine they have already received but could mix mRNA vaccines if necessary.

     There is no guidance yet for moderately/severely immunocompromised persons vaccinated with the J&J vaccine. The FDA is waiting for more data they hope to receive this month including the J&J 2 dose safety and efficacy phase 3 trial.  

Don’t Get Fooled by Numbers

        The higher the rate of fully vaccinated persons (FVPs) in a population, the larger the number of COVID cases we can expect to see in the FVPs of that population. That number can look large and scary like the report that 346 of the first 469 cases in Provincetown, Massachusetts occurred in FVPs; those FVPs represented a startling 74% of those initial cases. The more meaningful comparison would be the rate of infection of FVPs as a proportion of the total population of FVPs.

        Consider a mythical town of 100 people where 85 are fully vaccinated and 15 are unvaccinated. If there are 2 COVID cases among the FVPs and 2 cases among the unvaccinated, you can correctly say that 50% of the cases were among the FVPs. 

         

        You can keep this truth in perspective if you also remember that infection occurred in 2 out of 85 (or ~ 2.4%) of FVPs while infection was found in 2 out of 15 (or ~13.3%) of unvaccinated persons.

        We know we won’t be counting all COVID cases in either population because people with few to no symptoms are unlikely to get tested and no populations (except some schools and businesses) are doing surveillance testing at a level expected to significantly improve case detection. We can speculate that missed cases in FVPs might be more frequent if being fully vaccinated often reduces symptomatology.

  • DON’T let the “74% of cases” in Provincetown bother you.  
  • DO be justifiably alarmed that persons infected with Delta have viral loads 1,000 fold higher than previous COVID variants making transmissibility higher.
  • DO be concerned that infected FVPs have a viral load as high as the unvaccinated.
  • DO be concerned that persons exposed to Delta become infected on day 4, 2 days earlier than other variants, giving contact tracers less time to find and quarantine close contacts.

        The “consolation prize” for all of us is that FVPs infected with Delta appear to clear virus much more quickly than unvaccinated persons and may become untransmissible within ~48 hours of being infectious. That also suggests that their PCR tests could revert to negative more quickly, compounding some of our case identification problems.

Wednesday Not-So-Funnies

https://www.pinterest.dk/pin/410812797265428949/

https://imgur.com/gallery/cPU1pQt

Vaccine Record Submission, Exemptions and Campus FAQs (Students and Employees)

Basic Preventive Measures

  • Becoming fully vaccinated as soon as possible is your strongest protection
  • L.A. County Public Health guidance about when to wear a mask
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk
  • Isolate/quarantine when indicated (see below)

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 8-4-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and has added some in-person services.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have two more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on August 10th, August 24th and August 31st. These dates are open to students, staff, families and the community at large.

The Data that Changed the CDC Advice

        With respect to the pandemic, it is still as if we are building and modifying an airplane while trying to fly it. Last week the CDC urged all areas with substantial or high transmission to recommend masking for all regardless of vaccination status when in public indoor spaces. They also recommended that asymptomatic fully vaccinated individuals who have had close contact with a COVID case should be tested at 3-5 days after that exposure and mask in all public spaces for 14 days. The data that prompted these recommendations came from a cluster of cases in Provincetown, MA following multiple densely packed indoor and outdoor events that occurred 7/3/2021 to 7/17/2021.

        Overall, 69% of Massachusetts residents are fully vaccinated. In the first 469 cases linked to these events, 346 (74%) of them occurred in fully vaccinated persons; 80% of those fully vaccinated persons identified as cases were asymptomatic. There were 133 cases in which genomic sequencing was done and 89% were found to be the Delta variant. The most disturbing finding was that fully vaccinated and unvaccinated cases possessed nearly identical concentrations of virus in the nose. This was measured by reporting the cycle threshold (Ct) for the reverse transcriptase polymerase chain reaction test (RT-PCR) that diagnosed the cases. RT-PCRs are the very sensitive tests done on nasal, nasopharyngeal and sometimes oral swabs when looking for COVID infection in symptomatic persons or persons who have had close contact with a case. You won’t see a Ct value reported with your negative or positive COVID test result but it exists and it represents the number of cycles of amplification required for the virus in the sample to become detectable. A lower Ct value means there was a higher initial concentration of the virus. The 127 fully vaccinated cases for whom Ct was reported had an average Ct of 22.8. The 84 unvaccinated cases for whom Ct values were reported averaged 21.5.

        To provide a reference point, most RT-PCR machines are set up to call a specimen negative if virus is not detected after 40 rounds of amplification. Many would consider Ct values of ≥35 to be indeterminate. The Ct values for the fully vaccinated and unvaccinated persons in this study represent high levels of virus.

Balancing the Cost of Delayed Vaccination vs. Greater Side Effect Certainty for Children Under 12

        The FDA has asked Pfizer and Moderna to expand the number of children ages 5 through 11 in their vaccine trials. The desire is to be more certain whether the rare cardiac inflammation seen in older children and young adults occurs with any further increased frequency in these younger children. Greater numbers in the Phase 3 trials for children 5 through 11 would improve the chance of observing this and any other rare side effects that may be specific to this age group. Expert opinion since late June 2021 has been that the benefits of mRNA vaccination clearly outweigh the risks of cardiac inflammation for persons 12 and older. 

        Dr. Paul Offit is a pediatrician, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an internationally recognized expert in virology and immunology. He reminds us that COVID illness carries a risk for children and perhaps more so now with the high viral loads of the Delta variant. Some 4 million U.S. children and adolescents have been diagnosed with COVID so far and 346 have died. Delays in authorizing vaccination because of expanded trials can be expected to continue the exposure of these children to COVID. In Offit’s words, “there is always a human price for knowledge”.

New Estimates of Transmission and Lethality of Delta Compared to Original COVID

        An internal CDC document that became available on 7/30/2021 states that the Delta variant of COVID is almost as contagious as chickenpox. It may also be more likely to cause severe disease though it is extremely difficult to control for the multiple factors that contribute to severity of illness.

        You can see that transmissibility and lethality for the original and Delta variant of COVID are represented as ranges of values within a rectangle rather than the point estimates for seasonal flu, SARS, chickenpox and other illnesses.

Basic Preventive Measures

  • Becoming fully vaccinated as soon as possible is your strongest protection
  • L.A. County Public Health guidance about when to wear a mask
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk
  • Isolate/quarantine when indicated (see below)

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 7-21-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and has added some in-person services.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have two more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on August 3rd and August 24th. These dates are open to students, staff, their families and the community at large.

LA County Public Health Masking Requirements

     The 7/16/2021 LA County Health Officer Order (HOO) went into effect on July 17th. With very few exceptions, all persons are required to wear masks while indoors in public settings and businesses regardless of vaccination status. The persons exempt from mask requirements has not changed but this new HOO supersedes the Cal OSHA COVID-19 Emergency Temporary Standards adopted in mid-June that allowed fully vaccinated employees to be mask free.

     This HOO was prompted by the rapid rise in the daily average case rate from 162 in early June to >1,000 as of last week. As of the 7 days ending 7/20, the daily average is now 1,610 which is thankfully still far lower than the LA County peak in the winter. This can also be expressed as 110 total new cases per 100,000 persons over the past 7 days which identifies LA County as a location of high community transmission based on CDC criteria. The HOO instructs all persons living in the County of Los Angeles Public Health Jurisdiction to comply with the required masking and follow the Public Health recommended COVID infection control measures. These additional measures include completing vaccination, adding masking in crowded outdoor settings, choosing the best available mask, improving ventilation, physical distancing and moving activities outdoors whenever possible. Long Beach Public Health has announced that they plan to align with LA County Public Health. There has not been a change in guidance on the Pasadena Public Health Department website since the June 14th masking changes but my advice is to err on the side of caution and follow the stricter LA County Health Officer Order.

A Changed View of COVID Outcomes in Persons Living with HIV

     Early in the pandemic the data seemed to suggest that persons living with HIV who were hospitalized with COVID infection had no increased risk for severe disease and death. Those initial reports were based on small numbers of persons. They may have been biased by an increased tendency to hospitalize COVID patients living with HIV out of an abundance of caution, skewing that population towards less severe illness compared to hospitalized COVID patients without HIV.

    A recent study of over 15,000 hospitalized COVID patients who were also living with HIV found that they have a 30% increased risk of dying after adjusting for age, sex, disease severity and the presence of other conditions. Appropriate responses to recognizing this increased risk include promoting access to monoclonal antibody and anti-viral treatment for treatment of COVID in hospitalized patients living with HIV and prioritizing persons living with HIV for initial COVID vaccination and for consideration of booster doses along with other immunocompromised persons.

A Little About the Lambda Variant

     The Lambda variant was first seen in Peru in late 2020. It has become the dominant variant there as well as spreading through South America and to 29 countries around the globe in 5 different World Health Organization regions. Presently in the US it accounts for less than 1% of all sequenced samples.

     Lambda has a mutation (L452Q) that is expected to make it bind more tightly to the ACE2 receptors on human cells leading to increased transmissibility as has been seen with the Alpha, Beta and Delta variants that all have a similar mutation in the same location. Lambda has a second concerning mutation (F490S) that is likely to interfere with the binding of neutralizing antibodies that people produce in response to prior COVID illness or COVID vaccine. There is no indication so far that the Lambda variant will out-compete the Delta variant.

     A preprint study provides some hopeful news about these mutations that predict increased transmissibility and resistance to antibodies. They found that antibodies from persons with prior COVID illness and antibodies from persons with prior vaccination with Pfizer and Moderna were still successful in neutralizing the Lambda variant. The Regeneron combination monoclonal antibody treatment was also effective.

Wednesday Funny (chosen when we still hoped we had the bandwidth and opportunity to consider other issues)

https://www.newyorker.com/cartoon/a25645jpg?utm_source=onsite-share&utm_medium=email&utm_campaign=onsite-share&utm_brand=the-new-yorker

Basic Preventive Measures

  • Becoming fully vaccinated as soon as possible is your strongest protection
  • L.A. County Public Health guidance about when to wear a mask 
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Covid weekly update hiatus next week- watch for next update on 8/4/21

Clinic Physician: Ann Walker, MD

 

COVID Update 7-14-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and has added some in-person services.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have two more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075  to schedule appointments on August 3rd and August 24th. These dates are open to students, staff, their families and the community at large.

The Numbers in L.A. County

        The 7-day average of daily new cases in L.A. County was at a low point of 162 on June 3rd, rising to 432 by July 5th and then 851 as of July 13th. Test positivity and hospitalizations have also been rising but more slowly.

        There are just over 8 million people in L.A. County who are 16 years of age or older who can be vaccinated for COVID. As of data through July 9th, 69% of these persons have had at least one dose of vaccine and 61% were fully vaccinated. Full vaccination is what you need for the best protection against the Delta variant but even partial vaccination is better than no vaccination.

Revised CDC Guidance for K-12 Schools

        The CDC issued revised guidance on 7/9/2021 to support the full reopening of K-12 schools in the fall even if those schools cannot implement all of the CDC prevention recommendations. They are recommending “layered protection”, using combinations of distancing, masking, surveillance testing, enhanced ventilation, contact tracing, isolation, quarantine and vaccination to make these education settings as safe as possible while still making in-person education accessible to all students. Schools are asked to rely on advice from their local Public Health Departments in making decisions about when to tighten or relax prevention measures based on local conditions.

        The CDC points to multiple studies showing that transmission rates in schools implementing multiple prevention strategies are typically lower than or no higher than the transmission rate of their surrounding community. Children are making up a greater proportion of all COVID cases as more adults have been vaccinated, 14% now as compared to 7% a year ago. Hospitalization rates are still low at ≤2% and deaths are <0.03% of all child COVID cases.

        With the 7-day average of daily new cases of 851 as of 7/13/2021, L.A. County has a “substantial” transmission rate based on CDC criteria. That transmission rate will be considered “high” at a sustained 7-day average of >1,450 new cases per day.

        The California Department of Health and Human Services announced that the K-12 school year this fall will start with all students and teachers wearing masks regardless of vaccination status with enforcement decisions being left to local school districts.

Discussion of Booster Doses for Pfizer

        Pfizer met with Dr. Fauci, Dr. Rochelle Wallensky of the CDC, the director of the National Institutes of Health, the acting commissioner of the FDA and several other U.S. officials on 7/12/2021 to make their case for recommending a booster dose for their COVID vaccine. The Advisory Committee on Immunization Practices COVID-19 work group has been recommending that booster doses begin only after evidence of declining vaccine efficacy against illness and signs that variants have substantially altered vaccine protection. Pfizer says it has internal data to document falling antibody titers at 6-8 months after vaccination. They also point to a report from Israel that Pfizer efficacy for preventing asymptomatic and mild symptomatic disease was 64% as of June 6th although the efficacy for preventing hospitalization and severe illness was still well above 90%. Half of the small number of patients currently hospitalized in Israel for severe COVID are fully vaccinated. The majority of those have underlying conditions that increase their risk for severe disease. Israel has announced that all persons fully vaccinated with Pfizer who also have immunodeficiency will be given a third dose.

        France has studied Pfizer booster doses in a small number of solid organ transplant patients. Almost half of the patients who had no detectable antibody level after their second dose of Pfizer had a measurable antibody response after a booster dose. Transplant patients with measurable though low antibody level after 2 doses had a many times higher antibody level after a 3rd dose.

        There will be more questions to answer. We know that antibody levels are not our only tool for preventing COVID infection but we don’t know how much help we are getting from cellular immunity. There is also the question of whether repeated boosting of an immune response in a solid organ transplant patient might increase the risk for organ rejection. There are many in the U.S. and around the world who believe that there is more to be gained for all in defeating the pandemic by focusing vaccine doses on the unvaccinated around the world and in the U.S. rather than promoting a wide use of booster doses.

Wednesday Funny

https://www.instagram.com/gemmacorrell/?hl=en

Basic Preventive Measures

  • Becoming fully vaccinated as soon as possible is your strongest protection
  • L.A. County Public Health guidance about when to wear a mask 
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 7-7-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and has added some in-person services.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have three more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on July 13th, August 3rd and August 24th. These dates are open to students, staff, their families and the community at large.

Delta Variant in Los Angeles

        The good news is that COVID cases and hospitalizations in L.A. County are only 2%-4% of what they were at the peak of the winter surge. The troubling news is that average daily COVID cases have doubled in the past week and hospitalizations have risen by 30%. COVID deaths have not been increasing but we all remember that they lag behind cases and hospitalizations. The rate of increase in cases and hospitalizations in L.A. County is outpacing national figures where cases have increased by 10% and hospitalizations have still been slowly decreasing.

        The rise of the Delta variant is contributing to these changes. In the past week the Delta variant was involved in 25% of new cases nationwide but accounted for close to 50% of all L.A. County. This week the CDC estimate is 52% nationwide and 57% for California, Nevada and Arizona together. These mounting changes prompted L.A. County Public Health to strongly recommend that even fully vaccinated persons resume masking when indoors with people whose vaccination status is unknown.

Breakthrough Infections and COVID Transmission in Fully Vaccinated Persons

        All three vaccines in use in the U.S. are highly effective at preventing symptomatic COVID illness with only a slight reduction in that efficacy for the Delta variant. Breakthrough infections are COVID cases occurring more than 2 weeks after becoming fully vaccinated. When the CDC was still reporting all known breakthrough infections in late April the rate was 0.01% of all fully vaccinated persons. Since late April, only breakthrough infections resulting in hospitalization or death have been reported (0.003% and 0.0006% of all fully vaccinated persons respectively).

        Israel does more surveillance testing than the U.S. and has vaccinated 85% of adults. They have had a rise in cases due to the Delta variant that is small compared to the U.S. but, of those cases, 30% have been in fully vaccinated persons leading Israel to reinstate its mask mandate for all people.

        Breakthrough infection cases, especially those that are asymptomatic have a demonstrably lower concentration of virus which becomes undetectable several days sooner than in unvaccinated cases, reducing the risk of transmission to others. Data from Britain and Scotland document at least a 50% reduction in transmission of COVID to household members from both partially and fully vaccinated cases compared to household members of unvaccinated cases. There were also cases of transmission of Delta variant infection from healthcare workers with breakthrough infection during the spring surge in India.

    The information to consider in L.A. County includes:

  • the rising numbers of highly transmissible Delta variant cases,
  • the very low but not zero rate of breakthrough infection in fully vaccinated people,
  • and the very low but not zero risk of transmission of disease to others from persons with breakthrough infections.

These factors together support L.A. County Public Health strongly recommending that even fully vaccinated persons mask when indoors with persons of unknown vaccination status. This is especially true for fully vaccinated persons with advancing age or medical conditions that increase the chance of severe disease or who have household members who are vulnerable to COVID infection.

J&J and the Delta Variant

        J&J announced that their single dose COVID vaccine generated neutralizing antibodies for the Delta variant as well as a robust, durable cellular immune response. Retesting neutralizing antibodies and cellular immune function at 8 months after vaccination revealed a further increase in the immune response.

Correlates of Protection

        The University of Oxford reported in a preprint study that they have identified four immune markers that were linked with a reduced risk of COVID infection in persons fully vaccinated with the Astra Zeneca viral vector vaccine. The high efficacy of COVID vaccines has made it slower to identify correlates of protection because the process depends on observing COVID infection occurring after vaccination. If a correlate of protection can be identified, it could be used to gauge an individual’s response to vaccination, monitor for the need for booster doses and assess expected performance of next generation vaccines without large, lengthy clinical trials that are both costly and ethically questionable when there are existing effective vaccines. Moderna is expected to report its analysis of correlates of protection soon.

Wednesday Funny

Adapted from https://xkcd.com/2479/

Basic Preventive Measures

  • Becoming fully vaccinated as soon as possible is your strongest protection
  • L.A. County Public Health guidance about when to wear a mask
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 6-30-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students and will begin to add in-person services as of 7/6/2021. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. 

We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines on campus is scheduled to have three more dates. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on July 13th, August 3rd and August 24th. These dates are open to students, staff, their families and the community at large.

COVID Cases and Delta in L.A. County

        L.A. County has had an ongoing decline in new COVID case numbers, hospitalizations, and deaths since the last surge in January. The average daily new case rate fell to a low of 162 for the week ending 6/3/2021. The numbers of cases and hospitalizations have been slowly increasing since then with the average daily case number rising to 190 as of 6/23/2021.

        Only a small proportion of new COVID cases are sequenced in L.A. County to identify the variant of COVID responsible for the illness. For the most recent week, 123 infections were due to the Delta variant, compared to 64 for the prior week. About half of these Delta variant infections were located in the Antelope valley where vaccination rates are lower. All but 10 of these Delta variant infections occurred in unvaccinated or partly vaccinated persons.

        Data from Britain tells us that for fully vaccinated persons, the Pfizer vaccine is 88% effective in preventing infection with the Delta variant and 96% effective in preventing hospitalization. Prevention of infection with the Delta variant falls to 33% with partial vaccination with Pfizer.

        The advice for all is to become fully vaccinated as soon as possible. On 6/28/2021, L.A. County Public Health recommended that all persons wear masks in public spaces when you don’t know everyone’s vaccination status.

Mix and Match Vaccines

        The CDC and the FDA have taken the approach that any two-dose COVID vaccine series given in the U.S. should be completed with the same vaccine with which it was started whenever possible. Rare exceptions occur when a person develops a reaction to the first dose that is a contraindication for a second dose and when there has been unintentional mixing of doses.

        Other countries including Britain, Germany, France, South Korea and more have allowed mixed vaccination series. This has been driven either by the necessities of vaccine supply or caution as with the rare side effect of serious clotting with the Astra Zeneca vaccine in persons <60 years old. Vaccine supply has generally not been an issue in the U.S.

        Trials are underway to assess the possible benefits and risks of mixed series and the FDA would not be expected to approve an expansion of mixed series without clinical trial data support.

mRNA Vaccine Benefits Outweigh Cardiac Inflammation Risks

        The Advisory Committee on Immunization Practices (ACIP) reviewed the data on cardiac inflammation following mRNA COVID vaccination and advised the CDC that the benefits of vaccination outweigh the risks. The risk is highest after second doses and higher in men than women. This side effect is still quite rare at 12.6 cases per million second doses administered. Cardiac inflammation is much more common among persons with COVID illness than following vaccination.

        Chest pain, shortness of breath, and difficulty sleeping are the commonly reported symptoms for post-vaccination cardiac inflammation. Most cases are mild and respond well to anti-inflammatory medications. Anyone with cardiac inflammation after a first dose of mRNA vaccine should talk with their doctor and wait to get their second dose until their inflammation heals.

Wednesday Funny

https://www.kapwing.com/explore/types-of-headaches-meme-generator

Basic Preventive Measures

  • In addition to the guidelines for mask use as of June 15th, L.A. County Public Health recommends mask wearing in all indoor spaces regardless of vaccination status because of increased circulation of the highly transmissible Delta variant.
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Pasadena Public Health lists several vaccination opportunities.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 6-23-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244. We will respond to email inquiries during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Vaccines Close at Hand

        The PCC partnership with Rite Aid to administer COVID vaccines was up and running in the The Piazza on 6/22/2021 from 2pm-6pm. Use https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075 to schedule appointments on July 13th, August 3rd and August 24th. These dates are open to students, staff, their families and the community at large.

More on the Delta Variant

        Russia is experiencing rising numbers of COVID cases, especially in Moscow. Case numbers have tripled over the past two weeks and the Delta variant is responsible for 89% of all new cases. Russia is especially vulnerable as relatively few persons have been vaccinated; roughly 10% of the population is fully vaccinated.

        In the past week, Britain has expanded eligibility for a first dose of vaccine to persons 18+ while also prioritizing second doses. This has been prompted by rising numbers of new cases since early May with a 120% increase over the past 2 weeks. More than 90% of new cases involve the Delta variant.

        The Delta variant was ~10% of sequenced cases in the U.S. as of June 5th. That number is projected to rise to 20% when the data through 6/19/2021 is available to evaluate. Dr. Ashish Jha, Dean of the Brown University School of Public Health, believes Delta will be the dominant strain by August. Vaccine studies done so far reinforce the benefit of being fully vaccinated to prevent infection with Delta and the other COVID strains.

Options for Documenting COVID Vaccination

        If you have been given a COVID vaccine, you should also have been given the white CDC card documenting the date and type of vaccine you received. Like any other health document, this card should be securely stored. An image of this card stored in your email is one way to make this information accessible in most situations.

        If you lose your original record, you have several options. If you were vaccinated in a pharmacy, most will be able to give you a duplicate record on site or through their website. The California Department of Public Health opened a new portal for retrieving COVID vaccinations. Use your name, date of birth and the email address or cell phone number used in registering for the vaccine. If your information matches their records, you should receive an email or text message with the vaccination information. This electronic version of the paper vaccination card is not a “passport” or a requirement. The portal is off to a bumpy start with one out of eight persons having trouble retrieving their records.

        You can also complete the Authorization to Release Healthcare Information form for the California Immunization Registry to get an emailed record of all of your immunizations that are in the registry. If you are a PCC student and don’t have the government issued photo ID requested in the release or need your record sooner, contact Student Health Services at 626-585-7244 or medicalSHS@pasadena.edu for assistance.

Novavax Vaccine Efficacy in Recently Completed U.S. and Mexico Trials

        The results of the Novavax phase 3 trials conducted in the U.S. and Mexico show a 90% overall efficacy along with a 100% efficacy in preventing moderate and severe COVID in persons ≥18 years old. These trials were conducted December 2020 through April 2021. There were 77 COVID cases in these trials and 54 were sequenced; half of the sequenced cases were infections with the Alpha variant.

        The Novavax vaccine uses spike proteins from the COVID virus to stimulate an immune response. It does not require frozen storage, making it easier to use for a global disease. Novavax is also developing a new version of their vaccine based on the Beta variant that predominated in a South African trial of Novavax last year that ended with a low efficacy of 49%.

Disappointing Results for the CureVac mRNA Vaccine

        CureVac is a German company producing a mRNA COVID vaccine that does not require frozen storage. Earlier trials suggested that its efficacy might match the Pfizer or Moderna mRNA vaccines but interim results of their Phase 3 trials in South America and Europe showed an efficacy of only 47%. That rate might improve some after enough cases have accumulated for a final analysis but it is less likely that the vaccine will turn out to be highly protective. The interim data suggests that efficacy in persons ≤60 years old may be higher but the final results may still be unable to confidently support a difference in efficacy based on age.

        Nearly all the COVID cases in this interim analysis were sequenced and only one case was attributable to the original COVID virus. More than half of the sequenced cases involved variants of concern. The Pfizer and Moderna Phase 3 trials were completed at times and locations that did not include the current variants of concern but the real world experience with their use so far has shown that their efficacy only drops slightly.

Wednesday Visual - Graph of U.S. Deaths Over Time

Adapted from https://www.nytimes.com/2021/06/16/us/600000-us-covid-deaths.html  

Basic Preventive Measures

  • L.A. County has updated their guidelines for mask use reflecting advice as of June 15th.
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 6-16-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

COVID Vaccine Opportunities 

        PCC is partnering with Rite Aid this summer, offering the two dose Pfizer or the one dose J&J vaccines for students, employees and the public. Sign up today at https://www.eventbrite.com/e/covid-19-vaccination-clinic-tickets-157860189075. Reserve your time slot between 2pm and 6pm on June 22nd, July 13th, August 3rd and August 24th. Additional times and dates may be added.

        Got time now and wondering if there is a COVID vaccine available near you now? You can use the vaccinateLAcounty.com, myturn.ca.gov or vaccines.gov websites. Want a shorter list? Text your zip code to GETVAX (438829) to get up to 3 vaccine sites near you. For Spanish language results, use VACUNA (828862).

Masking and Testing Guidelines

        Last week, the California Department of Public Health (CDPH) posted mask guidance that went into effect on June 15th and the L.A. County Department of Public Health (LACDPH) announced they would align with the State guidelines. The CDPH and LACDPH guidance aligns with the CDC masking guidance.

        Masks are still required for all, regardless of vaccination status, on public transit, in healthcare settings, correctional facilities, homeless shelters, emergency shelters and cooling centers as well as indoors in K-12 schools, childcare and other youth settings. Unvaccinated persons are still required to mask in indoor public settings, businesses, meetings and government offices serving the public. Businesses may choose to: 

  • require all persons to mask, or
  • implement vaccine verification to determine which persons must mask, or
  • provide information to all about vaccination requirements to enter without a mask and allow vaccinated individuals to self-attest that they are in compliance.

        Cal OSHA’s newest revision of their Emergency Temporary Standards (ETS) for workplaces will come to a vote on 6/17/2021. Except for the settings mentioned above, it will allow most fully vaccinated workers to stop wearing masks and end physical distancing requirements. Unvaccinated persons would still be required to wear masks in indoor work settings covered by the ETS unless they are alone in a room with the door closed or distanced while eating or drinking. 

        LACDPH is emphasizing the importance of ongoing testing to identify and control COVID outbreaks as the state reopens. Free testing is still widely available across L.A. County and should be done for:

  • anyone with signs or symptoms of COVID despite vaccination status or recent infection
  • unvaccinated persons who have been in close contact with a confirmed COVID case
  • unvaccinated persons who spend time indoors around a lot of people not wearing masks even if asymptomatic.

Learning from Others About the Delta Variant

        Britain had been anticipating “freedom day” on June 21st when they hoped to lift the last COVID restrictions. Freedom day has now been postponed for 4 more weeks based on the uptick in cases due to the Delta variant. Now representing 96% of all COVID cases in Britain, Public Health England has found the Delta variant to be more transmissible than the Alpha variant it has overtaken. Hospitalizations with the Delta variant are double the previous rate. The total number of cases is currently small; keeping those numbers small may require a surge of vaccinations in COVID hotspots as well as increased testing and contact tracing. Persons fully vaccinated with the Pfizer or Astra Zeneca vaccines in Britain have only a slightly diminished efficacy for the Delta versus the Alpha variant. The efficacy for preventing symptomatic COVID disease with the Delta variant falls to 33% in partially vaccinated persons.

        China is also reporting an outbreak with the Delta variant. Patients are reported to be more symptomatic and to worsen more quickly with the Delta variant which is consistent with the higher viral concentrations recovered from infected individuals. Widespread testing, isolation of cases and quarantine of close contacts have slowed but not stopped the outbreak. China has not disclosed the vaccination status of identified cases.

        The California Department of Public Health reports that the Delta variant represents 4.4% of COVID cases sequenced in California as of 5/21/2021. All we know so far about the Delta variant should encourage everyone to become fully vaccinated as soon as possible.

Evaluating Reports of Heart Inflammation Following mRNA Vaccines

        The Advisory Committee on Immunization Practices (ACIP) provides guidance to the CDC on vaccine safety. They will be meeting on 6/18/2021 to review preliminary data on reports of inflammation of the heart following vaccination with Pfizer and Moderna vaccines. The reported symptoms include chest pain, shortness of breath and testing abnormalities and usually appear within days of vaccination. Most cases have been mild and at least 80% have full resolution of symptoms.

        The concern is that the reported symptoms appear to exceed the expected number of cases of cardiac inflammation for persons younger than 25. Two thirds of the persons with symptoms were male. There will be a careful review of persons with symptoms to identify true cases and to attempt to establish causation. Even though severe COVID is uncommon in young persons, the rare side effect of cardiac inflammation after vaccination is felt to pale in comparison with range of adverse outcomes from COVID infection in young persons.

Wednesday Funny

Adapted from https://www.hedgerhumor.com/  

Basic Preventive Measures

  • L.A. County has guidelines for mask use for people who are not fully vaccinated and for people who are fully vaccinated. 
  • Avoid confined spaces with poor ventilation, crowds and close contact to reduce your risk.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com; many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 6-9-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

New Names for COVID Variants of Concern

        The World Health Organization (WHO) has proposed new, shorter names for COVID variants of concern based on the Greek alphabet. The Phylogenetic Assignment of Named Global Outbreak Lineages (PANGO) naming system of B.1.1.7, B.1.351, P.1 and B.1.617.2, will continue to be used in research but the WHO recommends using Alpha, Beta, Gamma and Delta respectively for public communications. These names reflect the order in which these COVID variants of concern were detected. The PANGO names can be difficult in everyday communications and the hope is that the simpler Greek letter names will help people avoid references to the geographic locations where these variants were first detected.

COVID Vaccine and International Students

        International students make many contributions to U.S. colleges and universities through their academic talent, their impact on campus diversity, and their tuition dollars. Many of these students come from countries with limited COVID vaccine supplies, especially compared to the U.S. The CDC’s advice for persons vaccinated for COVID outside the U.S. is to accept any vaccine with an Emergency Use Listing (EUL) with the World Health Organization (WHO). Many colleges and universities with mandatory COVID vaccine policies will accept the WHO approved vaccines if all required doses have been received. Currently, the WHO EUL includes the Pfizer, Moderna and J&J vaccines in use in the U.S. as well as Astra Zeneca, Sinopharm Beijing (BBIBP-CorV) and Sinovac (CoronaVac) vaccines. Other vaccines in the process of being evaluated for inclusion in the EUL include the Russian (Sputnik V) and Indian (Covaxin) vaccines.

        Foreign students returning to a mandatory vaccination campus who are unable to get vaccinated before returning to the U.S. are likely to be asked to complete some combination of quarantine, remote learning, ongoing masking, and surveillance testing while acquiring fully vaccinated status in the U.S. The process is murkier for those who have been vaccinated with a product not currently on the WHO EUL or who have not completed a WHO EUL vaccine series. The CDC currently says they “may be offered a complete FDA-authorized COVID vaccine series” starting at least 28 days after the last dose of other COVID vaccine. COVID vaccines are not generally viewed as interchangeable and there is only preliminary data about mixing two different vaccines.

        The California State University system, the largest public university system in the country, is taking a broader approach. They will accept any completed vaccine series if the vaccine was approved in the country where it was given by an authority like the U.S. Food and Drug Administration.

COVID Colliding with HIV

        A patient in South Africa with inadequately treated HIV first became sick with COVID in September 2020. She was hospitalized briefly with supplemental oxygen as her primary therapy. After discharge, she was enrolled in a study of COVID patients with HIV and continued to have COVID virus present on monthly testing. Some six months later, when changes in her HIV treatment brought her HIV under control, she also stopped having positive COVID virus tests. Sequencing of the COVID virus recovered over the intervening months revealed an accumulation of 13 genetic changes in the crucial spike protein as well as at least 19 other genetic shifts elsewhere that could change the behavior of the virus.

        There are an estimated 8 million people in the world believed to be unaware that they are infected with HIV and another approximately 2 million HIV patients without good control of their disease. As COVID spreads in countries where there is both a lack of COVID vaccine and significant populations with untreated/under-treated HIV, those persons with both illnesses could become important sources of new COVID variants.

Thinking About the “When” and “Which” of COVID Booster Vaccines

        We already know that COVID vaccines do not prevent all COVID infections, but they are very good at preventing severe disease and death. Vaccine manufacturers will be continuing to follow their phase 3 participants for at least 2 years to monitor ongoing efficacy. On a national level, data on breakthrough infections in fully vaccinated persons resulting in hospitalization or death will continue to be monitored looking for any evidence of an uptick. We already know that the most effective protection for the world is the rapid completion of vaccination for all with any effective vaccine, which will drive down transmission rates of all variants of COVID.

        Additionally, the National Institutes of Health is approaching results for a trial of a dose of Moderna vaccine, following previously completed Moderna, Pfizer and J&J vaccination, to determine if the booster raises antibody levels and prolongs protection. Mixed booster trials are also underway in Britain and South Africa. While the current advice is still to complete an initial vaccination series with the same vaccine used for the first dose of a two-dose series, there is developing evidence that a mix of vaccine types for a booster may be beneficial.    

Basic Preventive Measures

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com and many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Remember there is no cost to you for the vaccine, and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 6-2-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Bring on the Incentives

      The State of California announced its “Vax for the Win” incentive program with $116.5 million in prizes. There will be 10 winners of the top prize of $1.5 million to be drawn on 6/15/2021. There will also be 30 winners of $50 thousand each, half selected on June 4th and half on June 11th. Almost all residents of California, regardless of immigration status, who have received at least one dose of COVID vaccine and are identified in the State’s vaccine registry as of the time of the drawings are eligible for these cash prizes and are included automatically. Prize money will be paid after the winners have been fully vaccinated.

        If you are a winner of these cash prizes, the California Department of Public Health will try to contact you by phone. They will make repeated attempts to contact you between 8am and 5pm. If they cannot reach you in 96 hours, they will move on to another winner.

        There will also be 2 million $50 prepaid cards or grocery cards distributed by email or text message to persons who have become fully vaccinated after a first dose on or after May 27th. If you believe you qualify but do not have email or a mobile phone, you can call 833-993-3873 to get a physical card. The same number can coordinate delivery if you do not have a permanent mailing address.

An mRNA Vaccine with Logistical and Financial Advantages

        CureVac is a German COVID Vaccine developer with a mRNA vaccine that is expected to have final results of its Phase 3 efficacy trials by late June. Unlike Pfizer and Moderna, the CureVac vaccine is stable for at least 3 months in a refrigerator which will make it easier to use in low- and middle-income countries. Researchers at the Imperial College of London also estimate that producing this vaccine may be one-half to one-fourth of the production costs of Moderna and Pfizer respectively, a large savings when you consider the billions of doses needed to vaccinate the world.

70% Vaccination May Be Achievable

        The message everywhere is vaccinate as many people as possible to drive down COVID infections, hospitalizations and deaths. A Kaiser Family Foundation survey in late May offers hope that despite a slower pace of vaccination, 62% of persons surveyed nationwide in May 2021 had received at least one dose of vaccine compared to 56% in April. Roughly 4% of unvaccinated respondents indicated that they wanted to start vaccination as soon as possible. Representing another 4% of survey participants, about one third of those previously categorized as “wait and see” reported that they had made vaccine appointments or planned to do so within the next three months. Added together, these groups of persons put a 70% vaccination rate in reach. The two groups with the greatest increase in vaccination between April and May were Latino adults, rising from 47% to 57%, and adults without college degrees, rising from 48% to 55%.

Falling Rates Hide Ongoing Risks for Unvaccinated

        Falling COVID cases, hospitalizations and deaths are making everyone feel better. This tends to obscure the ongoing risk of infection, hospitalization, and death for unvaccinated persons. The Washington Post adjusted case, hospitalization, and death rates by removing most vaccinated persons from the calculations since these events are extremely rare in vaccinated persons. They found on average that the adjusted rates of infection, hospitalization and death for unvaccinated individuals was 69% higher than the unadjusted figures. For young adults in Maryland this means that they have the same infection rate as they had in the January surge and a risk of hospitalization that has doubled.

        In Los Angeles County, the ongoing divergence of vaccination rates by ethnic and racial groups has led to Black residents now being twice as likely to be newly infected and two to three times as likely to die from COVID as Latino, White and Asian residents.

Basic Preventive Measures

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com and many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 5-26-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:00a-4:30p, Friday 8:00a-12:30p.

Predicting Current and Future COVID Vaccine Efficacy

        When thinking about preventing disease with a vaccine, a “correlate of protection” is a measurable immune response that is known to be responsible for and statistically related to protection from the disease. A group of researchers in Australia have demonstrated that early clinical trial data on neutralizing antibody levels for seven different COVID vaccines are strongly linked to those vaccines’ efficacy results from their phase three trials. The vaccines studied included Pfizer, Moderna and J&J which are in use in the U.S. Monitoring neutralizing antibody levels over time should help predict when booster vaccinations are needed. Because doing efficacy trials with unvaccinated persons as controls becomes unethical for serious diseases when effective vaccines have already been identified, a correlate of protection is also essential in developing and evaluating next generation vaccines.

Vaccine Efficacy and the B.1.617 Variant

        There has been concern about the COVID virus variant B.1.617 which has been responsible, along with the B.1.1.7 variant, for so many COVID cases in India. Like the B.1.1.7 variant, B.1.617 and its three sub-lineages are already known to be present in many parts of the world.

        Public Health of England has released information showing that the efficacy of the Pfizer and Astra Zeneca vaccines for preventing symptomatic Covid infection with B.1.617.2 was only slightly lower than the efficacy for those two vaccines against the B.1.1.7 variant in fully vaccinated individuals. In contrast, the vaccine efficacy for preventing symptomatic disease after a single dose of those vaccines may be as low as 33% for B.1.617.2. Part of the U.K. vaccination strategy has been to expand the time between first and second doses of vaccine to focus on getting more people at least partially vaccinated. The U.K. now plans to accelerate 2nd doses of Pfizer vaccine with persons who are over 50 or who are clinically vulnerable to provide better protection against the B.1.617.2 variant. The choice to shorten the Astra Zeneca dosing back to the 4 week interval from its clinical trials to improve its coverage of B.1.617.2 has to be balanced against the recognition that the 12 week dosing interval resulted in better efficacy for other strains of COVID. 

        Preliminary estimates in the U.K. suggest that the B.1.617.2 variant may be 50% more transmissible that the B.1.1.7 variant. The cases of B.1.1.7 have been falling and B.1.617.2 is likely to become the dominant COVID variant in the U.K. within a month. There have been 800 cases of B.1.617 detected in the U.S. so far based on the small percentage of infections that are evaluated with genomic sequencing. If you are not already fully vaccinated, use what we know about this variant so far to motivate you to finish the job.

A More Powerful Retrospective Diagnostic Tool

        The T-Detect COVID-19 test by Adaptive Biotechnologies has emergency use authorization for diagnosing previous COVID infection. The test is based on sequencing the DNA of T cells modified by the immune response to COVID infection to identify the broad set of T cell receptor proteins known to be associated with COVID illness. Compared to antibody tests for COVID which can have low specificity leading to a high rate of false positives, this T cell receptor test has a specificity of 100%. Antibody tests are also hampered by the normal decline in antibody levels after infection passes while the DNA changes in the T cells will persist. This may help in the evaluation of individuals with long COVID symptoms who did not have lab confirmation of infection at the time of their initial illness. The hope is that this T cell receptor test will also become a way to monitor the effectiveness of vaccines over time.

A Second Vaccine for Adolescents

        Moderna announced that TeenCOVE, its phase 2/3 study of adolescents aged 12 through 17, has reached its primary endpoint with an efficacy of 100% for fully vaccinated participants and 93% for partially vaccinated. The side effects experienced were consistent with what has been reported for adults: pain at the injection site, headache, fatigue, muscle pain and chills. There were no significant safety concerns identified to date and the participants will continue to be monitored by an independent safety monitoring committee over the next 12 months. An application to the FDA for Emergency Use Authorization is expected in early June.

Wednesday Thought for the Day

Adapted from https://xkcd.com/2457/  

Basic Preventive Measures

Quick Links to Resources

Vaccine Availability

  • Persons 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com and many sites available without an appointment. Call 833-540-0473 if you need help with appointments or transportation.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 5-19-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Masking Recommendations

        On 5/13/2021, the CDC made broad recommendations regarding masking and distancing for fully vaccinated persons. They acknowledged that decisions about implementation will be made by state, local, tribal government, and Public Health Departments. Masking is still required on all forms of public transportation and within transportation hubs such as airports and stations. Additionally, the recommendations do not apply to healthcare settings, prisons or homeless facilities and further guidance is to be developed on the local level for businesses, schools and other settings where it may be hard to determine who is or is not vaccinated.

        The California Division of Occupational Safety and Health (CalOSHA) sets requirements for all California worksites and does not meet again to discuss statewide guidance until May 20th. County Public Health guidance cannot be any less strict than CalOSHA and the California Department of Public Health. California’s state secretary of Health and Human Services, Dr. Mark Ghaly, announced on 5/17/2021 that California mask guidelines would not be revised until 6/15/2021 to give more time for people to be vaccinated. A person is considered fully vaccinated at two weeks after the final dose of a COVID vaccine and there is currently no expiration time on that fully vaccinated status. It is hoped that relaxed masking and distancing advice for fully vaccinated persons will be an added incentive for more individuals to become fully vaccinated.

        The difficulty is not the science behind the recommendations. A very small number of fully vaccinated persons have breakthrough infection with COVID. The low levels of virus in those breakthrough infections makes transmission even more unlikely. The challenge is in the numbers of persons still without immunity in the setting of a virus that is still capable of great harm especially in communities already disproportionately affected by COVID. Recommendations intended to apply only to fully vaccinated persons without a workable process for monitoring vaccination status are difficult to implement without increasing the risk to those who are not fully vaccinated. If masking and distancing are relaxed locally, any fully vaccinated person who also has a compromised immune system should make decisions about continued masking and distancing in consultation with their healthcare provider and anyone who is not yet fully vaccinated should mask and distance until full vaccination is achieved.

Insight into Factors Behind Lower Vaccination Rates

        A recent Kaiser Family Foundation poll found that difficulty with access, misinformation about cost and concerns about employment and immigration issues are bigger contributors to lower vaccination rates in the Hispanic population than vaccine hesitancy. As of 5/9/2021, 59% of L.A. County residents 16 and older have had at least one dose of COVID vaccine but that figure is ~40% in Hispanic residents. Two-thirds of unvaccinated Hispanic poll respondents were concerned about missing work for side effects; more than half would get vaccinated if employers gave them paid time off to get vaccinated and recover from side effects if they occurred, something the federal government has encouraged companies to do.

        Nearly 40% of unvaccinated Hispanic respondents were concerned that vaccination would require a government ID (it does not) and a third worried that vaccination could jeopardize immigration status for them or a family member (it does not).

        In L.A. County, more vaccination sites are open with evening hours and almost all sites can take people without appointments, both of which makes access easier for working people. There is also a process to request a mobile vaccination team for businesses and community organizations. L.A. County Department of Public Health reported that there were 185 mobile vaccination teams last week and more planned for this week.

mRNA Vaccines and Pregnancy

        The clinical trials for the Pfizer and Moderna mRNA COVID vaccines did not enroll pregnant persons. Testing vaccines in pregnancy has always been controversial and the initial impression was that COVID infection might not represent increased risk for a poor outcome in otherwise healthy, younger people and their babies. More recently, a review of studies including a total of more than 400,000 pregnancies demonstrated that COVID infection in pregnancy is associated with a doubled risk of still birth in addition to increased risks for preterm birth, maternal death, and a higher rate of severe complications of all kinds.

        Though current pregnancy was a barrier to being enrolled in a clinical trial, there were many pregnancies that occurred in the course of the trials with no safety concerns detected. More than 35,000 pregnant persons vaccinated with Pfizer or Moderna between December 2020 and February 2021 were evaluated through multiple vaccine surveillance systems; there were no increased pregnancy or birth complications or identifiable risks to the baby among those who were vaccinated. The immune response of pregnant persons to mRNA vaccines is stronger than the response in COVID illness in pregnancy. While the decision to vaccinate during pregnancy belongs to the pregnant person, the safety and benefits of doing so mean that it should be offered to all.

Wednesday Funny – A Cartoonist’s Post-Pandemic Anxiety

Adapted from https://www.instagram.com/p/CMPpnmJL053/

Basic Preventive Measures

Help more people live to see and hug their family and friends outside their household again:

Quick Links to Resources

Vaccine Availability

  • All persons ages 12 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLAcounty.com and most sites available without an appointment
  • Kaiser has a separate state vaccination programs open to non-members.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 5-12-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Redefining Goals?

     Reaching herd immunity and eliminating COVID illness appears to be less likely. This is true on a local level where vaccination rates are slowing and most certainly on a global level where vaccine supply and distribution mean that much of the world will be waiting months to a year (or more?) for a chance to be vaccinated. The estimated vaccination rates needed to reach herd immunity have also risen over time, due in part to variants with higher transmissibility.

     The good news is that the change in the frequency of COVID illness is not an all or none response to the effect of population immunity, but more of a sliding scale effect. Rising vaccination rates will reduce COVID transmission and illness even if not far enough to snuff it out. If we continue to focus vaccination efforts on the populations most likely to have severe disease and death we can limit the severity of the outbreaks that still occur. This doesn’t mean that lower-risk individuals should take a pass on vaccination; lower risk of severe disease and death is not the same as zero risk. We know that even mild COVID can result in “long COVID” symptoms of uncertain duration. Immunity in these lower risk persons contributes to the overall lower transmission of COVID.

     How much disease and death will we accept from COVID? The answer is likely to vary a lot based on cultural, ethical, and political considerations, and will be influenced by what we learn over time about the duration and severity of “long COVID” symptoms. Nations will do their best to avoid their healthcare systems buckling under COVID. Perhaps our current coexistence with influenza could be a gauge. In the US, there has been an average of 35,000 influenza deaths annually in the ten years prior to COVID. Current deaths due to COVID in the US are over six times higher than that at the 7-day moving average of 608 deaths per day on May 9th.

What Patent Waivers Might Accomplish

     On 5/5/21 President Biden proposed a temporary waiver of intellectual property rights for COVID vaccines at the World Trade Organization (WTO) general council. Low- and middle-income countries have been pushing for months to find ways to accelerate both vaccine production and their access to vaccines. COVAX, the vaccine access program set up by the World Health Organization, has had difficulty in competing with wealthy nations for the limited vaccine supply, in part due to underfunding. CARE International, a global humanitarian organization dedicated to saving lives and ending poverty, estimates that for every $1 Of COVID vaccine on the runway in a developing country it will cost another $5 to complete a vaccination.

     There are numerous hurdles to a patent waiver. The WTO won’t negotiate details of adjusting patents unless all the member countries agree on a waiver, which until now had been blocked by the UK, the European Union, Japan and the US. Ngozi Okonjo Iweala, director general of the WTO, has set a target of December 2021 for reaching agreement on a waiver. In addition to concerns that waiving patent rights would remove needed incentives and threaten future innovation, some in the pharmaceutical industry argue that intellectual property is not the main barrier to vaccine access. Some suggest that the US waiver proposal is an effort to spur vaccine manufacturers and other developed countries to find more practical ways to increase vaccination in the developing world. Maybe the US could start with more information on completing safety checks for the Astra Zeneca doses in the US that we have said we would share. Even when there is no easy fix, the global response has become more important as national borders rarely protect any nation from pandemic disease.

Some Further Data of Pfizer Efficacy for Variants

     Over 385,000 Pfizer vaccine recipients in Qatar were followed from December 2020 through March 2021 with over 265,000 becoming fully vaccinated. During this time, Qatar’s new COVID infections came to be evenly split between the B.1.1.7 and the B.1.351 variants. For fully vaccinated persons the vaccine efficacy for preventing any documented infection with B.1.1.7 was 90% and B.1.351 was 75%. Vaccine efficacy for preventing severe disease and death was 97% for both variants. The data underscored the importance of getting both doses; efficacy for preventing any documented infection with only one dose was 30% for B.1.1.7 and 17% for B.1.351. A single dose of vaccine had an efficacy of only 40% for preventing severe disease and death for both variants.

Pfizer’s Next Steps

     Pfizer BioNTech has requested full approval from the FDA for its COVID vaccine for persons age 16 and older. It may take two months to review the 6 months of follow-up data submitted. On May 10, the FDA expanded the Emergency Use Authorization for the Pfizer vaccine to include children ages 12 through 15. The Advisory Committee on Immunization Practices is expected to review the data and make recommendations about its use through the CDC. Pfizer is also anticipating submitting an EUA application for use in children ages 2 through 11 in December 2021 pending the result from trials that started in March and April of 2021.

Wednesday Funny

https://xkcd.com/2460/

Basic Preventive Measures

Help more people live to see and hug their family and friends outside their household again:

Quick Links to Resources

Vaccine Availability

  • All persons ages 16 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLACounty.com
  • Kaiser has a separate state vaccination programs open to non-members.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers. 
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

 

COVID Update 5-5-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Easier to Get a Vaccine

    A growing number of LA County and City vaccination sites are accepting walk-ins in addition to continuing to offer vaccinations by appointment. Scrolling through myturn.ca.gov, vaccinateLACounty.com and the Kaiser non-member links showed multiple locations with same-day appointments and several accepting people without appointments. The myturn.ca.gov registration process also offers help arranging a home vaccination appointment or transportation to a vaccine site. If you have an appointment at a site that is also offering walk-in vaccination and the lines look long, ask if there is an expediter to facilitate your progress.

    Over the month of May, the Dodger Stadium mass vaccination site will be winding down and many of its resources will be added to other vaccination sites. Efforts to make vaccination more easily available, especially in communities with lower rates of vaccination, will spur an increasing number of mobile, pop-up and community-based sites. More than 50% of LA County White and Asian American residents ages 16 and older have received at least one dose of vaccine compared to only about 30% of similarly aged Latino and Black residents. The County will continue to work through community outreach groups where there are high rates of unvaccinated residents, especially as the data becomes clear that protection from COVID by virtue of prior COVID illness is less effective and durable than protection by vaccination.

     Changes to improve the availability and accessibility of vaccinations is being accelerated by the recent 50% drop in first dose appointments, evidence that many of the persons most ready to be vaccinated have already done so.

Why You Want that Second Dose of Pfizer or Moderna Vaccine

     Nationwide, about 8% of persons who got a first dose of Pfizer or Moderna COVID vaccine have missed their second dose appointment. This is not an unusual rate for multi-dose vaccines but COVID is not a “usual” problem. The rate of missed second dose appointments in LA County is a more disturbing 18%. Some may be hesitating because they are concerned about side effects, which can be more pronounced with the second dose. Some had their second dose appointments cancelled when vaccine supply was a problem. Some with a history of COVID illness may think one dose is enough. Others may be misinterpreting information about the immunity from a single dose of Pfizer or Moderna and making unproven assumptions about its strength and duration.

     When thinking about side effects, remember the tendency of social media to promote an “Olympics of suffering” with each post trying to top the one before it. Fatigue, headache, muscle aches and fever are more common on average with second doses of mRNA vaccines, but they do not occur in all persons and they are transient. The US supply of these vaccines is now more plentiful, so access is a much smaller issue. Second doses are important because they induce a 10-fold higher level of neutralizing antibodies. The second dose is also important for creating and maturing the T and B cell immune responses that contribute to durability of immunity as well as protection for variant strains. Beyond the health considerations, skipping that second dose could make life more complicated if travel and other activities require proof of full vaccination.

     Some other information to keep in mind about second doses:

  • It is never too late to get a second dose. While we want you to get your second dose on time, you don’t start over if you are late – you pick up where you left off.
  • Wherever you go for your second dose, take the vaccination card from your first dose.

          o   The ideal scenario is to get your second dose from the same provider as your first.
          o   More LA County sites are offering “stand alone” second doses to persons who got   
               their first dose elsewhere.
          o   Pharmacies getting vaccine from the federal government have been instructed to     
               offer second doses to people who got their first dose elsewhere.
          o   Make sure you choose a site offering the same vaccine as your first dose.
          o   Lost the vaccination card? There should be an on-line immunization registry record
               of your dose(s). For most of California you can get a copy of your record from the
               California Immunization Registry using their authorization to release health
               information. After confirming your identity, Student Health Services can make a
               request on your behalf if you don’t have the ID the Registry requests.

  • Do get a second dose of Pfizer or Moderna even if you had COVID illness before or after your first dose. You should not assume that your immune response after COVID is equivalent to a dose of vaccine. Wait to vaccinate until you are off isolation, usually the eleventh day after your symptoms started or after your test was positive if you had no symptoms. 

More About Breakthrough Infection in Fully Vaccinated Persons

     A fully vaccinated person is anyone at least 2 weeks out from completing COVID vaccination. When a fully vaccinated person is found to have COVID infection it is called a breakthrough infection. Breakthrough infections are seen with all vaccine-preventable diseases. The two most common issues increasing the risk of breakthrough infection are an impaired immune response in the vaccinated person and mutations in the infecting virus that shield it from the immune response.

     When vaccination first began for residents and staff in nursing homes in December 2020, there was a 96% drop in COVID cases in those settings as measured by late March 2021. In a study of 75 of 78 Chicago nursing homes with 627 COVID cases over that time frame, only 22 occurred in fully vaccinated residents and staff as detected by active surveillance testing. Two-thirds of those breakthrough infections were asymptomatic. The viral load was found to be low in the breakthrough infections where it was evaluated, consistent with the absence of documented transmission from the persons with breakthrough infection to others.

     The CDC is continuing to collect breakthrough infection data nationwide from Public Health Department reports and the Vaccine Adverse Events Reporting system. As of 4/26/21 with over 95 million fully-vaccinated persons, there have been 9,245 breakthrough infections (1 out of every 10,000 fully vaccinated persons). We know these more passive surveillance approaches will be missing some of the mild and asymptomatic cases. Following the data that is available and doing genomic sequencing in breakthrough infection cases identified will help assess ongoing immunity from vaccination and monitor for the impact of COVID variants on that immunity.

Wednesday Funny – Another Post-Pandemic Anxiety

Adapted from https://www.instagram.com/p/CMPpnmJL053/

Basic Preventive Measures

Help more people live to see and hug their family and friends outside their household again:

Quick Links to Resources

Vaccine Availability

  • All persons ages 16 and older are eligible for vaccination. Use myturn.ca.gov for availability all over California.
  • Access Los Angeles vaccine providers through vaccinateLACounty.com
  • Kaiser has a separate state vaccination programs open to non-members.
  • Trying to help someone outside California get vaccinated? Vaccines.gov is a national level approach to connecting people to vaccine providers.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 4-28-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

More Places to Find COVID Vaccine in L.A. County

        L.A. County added the Lancaster and Palmdale Metrolink train stations as COVID vaccination sites. These sites will operate 10:00a to 7:00p, Tuesdays through Saturdays with 250 vaccine doses per day. Appointments can be made through RemediaCare but the sites will also offer vaccinations without appointments when there are doses available. Metrolink has also started a Vaccine Clinic Locator tool listing vaccine sites that are within 3 miles of Metrolink stations.

     Looking for a car ride to a vaccine site? The ride-share service Lyft is offering some free and discounted rides to vaccine sites for some eligible persons. The site also accepts donations to support rides for others and reminds you how to set up a ride for someone else on your Lyft app.

Pause Lifted for J&J Vaccine

        After input from the Advisory Committee for Immunization Practices at the CDC, the FDA ended the pause on the J&J COVID vaccine and added a label warning about the risk of rare blood clots. Over the course of the pause, a small number of additional cases of rare blood clots were identified, bringing the total to 15 out of the nearly 7 million persons vaccinated. The revised fact sheet for vaccine recipients reviews the symptoms that should prompt evaluation for this rare complication. Modeling at the CDC suggests that if vaccinations resume in all adults, 26 to 45 cases of the clotting problem would be expected over the next 6 months along with 600 to 1,400 fewer COVID deaths in the same time period. The patient fact sheet also reviews information you should discuss with your medical provider or vaccination provider before getting the J&J vaccine.

The Two Out of Three Approach to Masking

        Even though there are very few cases of COVID believed to be the result of outdoor transmission, some states still have strict outdoor mask mandates even if no one else is present. The Los Angeles County Department of Public Health mask webpage still recommends masking when outdoors when with persons outside your household in their “when to wear a mask” section. Is it a conflict that the very next section says a mask is not needed if you are exercising outdoors and distanced? The distinction is to recognize the addition of distancing in the second scenario. To lower the risk of COVID transmission in all settings, make sure your activity meets two out of three of the following conditions: outdoors, distanced or masked. If you are outdoors and you stop to have an extended conversation with an unvaccinated person outside your household, you should consider wearing a mask as you may end up being less distanced than you think.

        For fully vaccinated persons, the CDC just released guidance on a variety of outdoor activities as being safe without a mask. The exception was for crowded outdoor events like live performances, parades, or sporting events. They also stress that you should consider the overall level of COVID illness in your community when making decisions about risk.

Another Large Study of Outcomes in Patients with Long Covid

        The Veterans Affairs health system published a study of the health effects on 73,000 patients across the U.S. with prior COVID infection that had not required hospitalization. They followed these patients between the first and sixth month after COVID infection and compared the frequency of death and the onset of new illnesses with nearly 5 million patients without prior COVID who were otherwise matched for multiple variables. They found that the risk of death over that period was 60% higher for the patients with prior COVID infection. They also had a 20% greater chance of needing outpatient medical care for new medical issues over that time than persons who had not contracted COVID.

     The study has limitations. It cannot distinguish between the direct effects (e.g., aberrant immune responses) and indirect effects (e.g., social, economic, and behavioral changes) of COVID illness. The predominantly male composition of the VA population with a median age of 61 may also fail to identify clinical outcome differences for females and younger persons.

Wednesday Funny – How to Talk to Your Immune System

https://xkcd.com/2443/

Basic Preventive Measures

Help more people live to see and hug their family and friends outside their household again:

  • Continue to limit your close contact to people within your household.
  • Use social distancing, wear a mask (or two), choose outside or other increased ventilation, and wash your hands.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Eligibility/Appointments

  • For vaccine eligibility and appointments all over California, use myturn.ca.gov – the key to success is persistence and an ability/willingness to reenter your information multiple times.
  • Kaiser has a separate state vaccination programs open to non-members.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 4-21-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

COVID Vaccine Eligibility in LA County

        Everyone 16 and older is eligible for COVID vaccine as of 4/15/2021. There are 700+ vaccination sites in L.A. County counting the city and county sites that get vaccines from the state allocation along with the multi-county entity (Kaiser) and pharmacies that get vaccines directly from the federal government.

        Along with myturn.ca.gov and the Kaiser non-member link, you can also search through VaccinateLACounty.com and vaccinefinder.org. No email or mobile phone? You can access the myturn appointments by calling 833-422-4255 (Mon-Fri 8a-8p, Sat-Sun 8a-5p). If you have a disability or no internet, you can access the VaccinateLACounty appointments by calling 833-540-0473 (8a-8:30p, 7 days/week). The VaccinateLACounty.com online information also includes pharmacy appointment weblinks.

        If you are getting vaccinated in L.A. County you will need:

  • a photo ID, and
  • proof that you live or work in L.A. County, and
  • proof that you are 16 or older

        MINORS: If you are 16-17 years old, you must choose a site offering the Pfizer vaccine and you must bring a parent or guardian with you for your appointment. Though all vaccine providers are required to ask for information to verify uninsured status (such as a social security number, driver’s license or state ID) that information is not required to be vaccinated and COVID testing, treatment and vaccination will not impact anyone’s current or future immigration status.

The J&J Vaccine Pause

        Use of the J&J COVID vaccine was paused last week after the identification of 6 cases of a rare clotting problem with the expectation that there are other cases to be counted. These cases occurred in the nearly 7 million persons given the J&J vaccine in the U.S. These are cases of cerebral venous sinus thrombosis (CVST), clotting in the venous collecting system in the brain, but some also had rare abdominal vein clotting. The more common medically significant clotting cases in the U.S. occur at a rate of 1,000 to 2,000 events daily. These rare CVSTs had been thought to occur in about 5 out of a million persons per year though improved imaging over the past decade shows that the rate may be closer to 20 per million persons per year. With a U.S. population of 331 million, that translates to 4 to 18 cases per day in the U.S.

        With millions of people being vaccinated every day, some of these rare clots would be expected to occur in those receiving shots just by coincidence. It remains to be seen whether these U.S. CVST cases will also be found to have antibodies to platelet factor 4 (PF4). Platelets are a type of blood cell that helps with clotting. These PF4 antibodies have been found in many of the 222 cases of CVST with low platelet counts among the 34 million doses of Astra Zeneca vaccine given around the world. The PF4 antibodies are believed to both deplete platelets and cause the clot formation.

        Pausing use of the J&J vaccine allows time to investigate the cause of these clotting events. It also allows time to advise healthcare providers and vaccinated persons about:

  • the symptoms that are seen with these clots,
  • the groups of persons who may be at increased risk for these clots,
  • how the treatment of these clots differs from more common serious clots.

        If CVST clotting is determined to be due to the vaccine, the pause allows time to decide if there are groups who should not be given this vaccine.

        The Advisory Committee on Immunization Practices (ACIP) met last week to begin reviewing the data. It remains to be determined when they will make final recommendations to the CDC and FDA about the future use of the J&J vaccine. When evaluating the risks, it will be important to remember the high efficacy of the J&J vaccine in preventing severe COVID illness especially with the knowledge that on average one in 200 persons with COVID illness will die. With these rare clotting problems being evaluated in the Astra Zeneca and the J&J vaccines, the follow-on question will be whether this is a “class-effect” of adenovirus viral vector vaccines which may also be seen with the Russian Sputnik V and the Chinese CanSino vaccines as well as other adenovirus viral vector vaccines.

        If the use of J&J vaccine needs to be limited, the international impact will be large. The inexpensive J&J one dose vaccine with simpler storage requirements was going to be a key player in addressing vaccination in countries with fewer resources. The initial effect of limited use of the J&J vaccine on the U.S. would be smaller, as to date, it has represented only 5% of the U.S. vaccinations. Even so, the transparency with how this evaluation is made and the skill in communicating the recommendations will be crucial to maintaining confidence in all vaccines.

Time to Reconsider Timing Between mRNA Vaccine Doses?

        The safety and efficacy trials for Pfizer and Moderna mRNA vaccines each studied a single dosing interval, 3 weeks for Pfizer and 4 weeks for Moderna. The initial Astra Zeneca vaccine trials also used a 4-week dosing interval. The usual approach is to follow those dosing intervals carefully. As a result, there were raised eyebrows when Britain decided to prioritize first doses over second doses with up to a 12 week interval between those doses, first for the Astra Zeneca vaccine and then also for the Pfizer vaccine.

        While Britain and the U.S. have given similar numbers of total vaccines per capita, and even though Britain has had a far higher prevalence of the more contagious B.1.1.7 variant, the pandemic is under better control in Britain than the U.S. at present. For the Pfizer vaccine, this is in line with the reports of an 80+% efficacy seen with first doses of mRNA vaccines.

        One concern with an increased dosing interval has been that the delay might promote the development of new variants. That has not been seen in Britain where the frequency of genomic sequencing has been high enough to hope to recognize new variants. In the U.S., cases and hospitalizations have been rising again and deaths have stopped declining while the B.1.1.7 variant has continued to increase in frequency. While pleading with people to continue masking, distancing, and avoiding mingling whenever possible, should we reconsider delaying second doses to double the number of people to benefit from the protection of a first dose over the coming weeks?

Encouraging News from Israel for Children Waiting to be Vaccinated

        While the Pfizer vaccine may be approved for use in children 12 to 15 as soon as this fall, it will be longer before the same can happen for children under 12. Israel has led the world in vaccinating adults. Following the data in 223 communities, they found that for every 20% increase in adult vaccination there has been a 50% reduction in COVID infection rates in unvaccinated children. This outcome is even more reassuring when you know that the data was collected at a time when the more transmissible B.1.1.7 variant was dominant.

Wednesday Funny – Further Post-Pandemic Anxieties

Adapted from https://www.instagram.com/p/CMPpnmJL053/

Basic Preventive Measures

        Help more people live to see and hug their family and friends outside their household again:

  • Continue to limit your close contact to people within your household.
  • Use social distancing, wear a mask (or two), choose outside or other increased ventilation, and wash your hands.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Eligibility/Appointments

  • For vaccine eligibility and appointments all over California, use myturn.ca.gov – the key to success is persistence and an ability/willingness to reenter your information multiple times.
  • Kaiser has a separate state vaccination programs open to non-members.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 4-7-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

New CDC Guidance on Travel for Fully Vaccinated

        While the CDC prefers that all people avoid travel, they announced on 4/2/2021 that fully vaccinated persons can travel, at low risk domestically and abroad, if they take basic precautions of masking and distancing. For domestic travel, the CDC guidance would not require COVID testing before or after travel and would not require quarantine after travel. Be sure to check for entry requirements at your domestic destination. For international travel, you do not need COVID testing before leaving the U.S. though it is required by most destinations. To re-enter the U.S., you will still need to show a negative test result performed within 3 days of your return departure and are recommended to retest 3-5 days after your re-entry, but the CDC guidance will not instruct you to quarantine. For fully vaccinated persons who also have history of documented COVID illness within the previous 90 days, there are instructions about documentation of recovery instead of further COVID testing. There are parts of the CDC international air passenger FAQs from 3/2/2021 that still need to be harmonized with the new CDC guidance.

        The CDC definition of fully vaccinated is ≥2 weeks after the second dose of a Pfizer or Moderna series or ≥2 weeks after the single dose of Johnson & Johnson vaccine. Be aware that state and county travel rules can be stricter than the CDC for both domestic and international arrivals, so be sure to check the rules for your destination. The Los Angeles Public Health Travel Advisory and Guidance was revised on 4/5/2021 to incorporate the CDC changes for fully vaccinated travelers and also modified the post-travel quarantine options for persons who are not fully vaccinated. Post-travel quarantine can now end after 7 days if a COVID test collected 3-5 days after return is negative. Without a test, post travel quarantine ends after 10 days and all persons should watch for COVID symptoms for 14 days after travel.

Preliminary Pfizer Results for Children Aged 12-15

        Children under 18 account for about 23% of the population in the U.S. Being able to vaccinate children will move the country closer to a level of immunity that will further decrease COVID illness.

        Preliminary data from a Pfizer trial of 2,260 children aged 12-15 found no symptomatic infections in the vaccinated group and no serious side effects. While details have not yet been peer reviewed, Pfizer reports that these vaccinated children produced more antibody than was seen with the participants aged 16-25 in their earlier trial. Pfizer plans to request an amendment to their emergency use authorization for their vaccine and hope to begin vaccinating these children in Fall 2021. Pfizer’s trial in children aged 5-11 is underway with the goal of approval for vaccination in early 2022.

        Moderna’s results for children aged 12-17 are expected within a few weeks and results from Johnson & Jonson and Astra Zeneca will come next.

Reason for Continued Caution

        Early 2021 was looking good with new COVID cases dropping by 80% in the U.S. until early March when the declines began to stall. First, only a few states returned to rising cases in the Midwest and Northeast. More recently, about two thirds of all states have case rates higher than their lowest point in 2021, adding up to a 20% increase in new cases in the U.S. since the lowest point in March.

        For states where there is enough genome sequencing to establish a clear trend, the B.1.1.7 variant is fueling 25% to 75% of the cases on an increasing trajectory. There are other variants present in California (B.1.427/B.1.429) and in the Northeast (B.1.526) but their prevalence has not increased over the recent months.

        In Michigan, hospitalizations for COVID have tripled over the past month. Nationwide the rise is more subtle but there is a shift overall to persons under 50 while hospitalizations for those over 65 are still declining.

        Vaccination is helping and data from Israel, where B.1.1.7 was previously highly prevalent, confirms that vaccines are effective against this variant. On a national level, with 167 million vaccine doses administered as of 4/4/2021, almost one third of the population has had at least one dose and almost a fifth of the population is fully vaccinated. Avoiding another wave of COVID cases while waiting for broader vaccination will require cautious implementation of new activities allowed by relaxed guidelines and a continued commitment of all to masking and distancing.

Wednesday Funny – Another Post-pandemic Anxiety

       

Adapted from https://www.instagram.com/p/CMPpnmJL053/

Basic Preventive Measures

        Help more people live to see and hug their family and friends outside their household again:

  • Continue to limit your close contact to people within your household.
  • Use social distancing, wear a mask (or two), choose outside or other increased ventilation, and wash your hands.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Eligibility/Appointments

  • For vaccine eligibility and appointments all over California use ca.gov – the key to success is persistence and an ability/willingness to reenter your information multiple times.
  • Kaiser has a separate state vaccination program open to non-members.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 3-30-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Expanding Vaccine Eligibility

        On 3-25-2021, Governor Newsom announced that persons 50+ years of age will be eligible for vaccination as of April 1st and persons 16+ years of age will be eligible as of April 15th. The good news this time is that the expanded eligibility is expected to be accompanied by increased vaccine supply. The current California allocation is 1.8 million doses per week and is expected to increase to 2.5 million doses per week in the first half of April and greater than 3 million doses per week by late April.

        These expansions in eligibility and vaccine supply come with several additional measures to aim for more equitable vaccination access for communities that have been the most impacted by COVID cases and deaths. Even with expanded vaccine supplies, it is expected to take several months for willing Californians to be vaccinated. During that time and beyond, it is very important to continue masking, distancing, and handwashing if we don’t want to start looking like several other states where cases are again on the rise.

Cal State L.A. Vaccination Site Scheduled for Change

        The Federal Emergency Management Agency and the California Office of Emergency Services announced the planned closure of the Cal State L.A. vaccination site as of April 11th. L.A. County and the City of Los Angeles are exploring options for taking over operation of this site and the community pop-up vaccination clinics it supported.

        This would be no small task. Running the Cal State L.A. site and its mobile clinics has required ~1,500 staff and has cost $10 million per week. The Cal State L.A. site has achieved 6,000-7,500 vaccinations per day and has delivered more than 24,000 vaccinations through its mobile clinics. Nearly two thirds of all vaccinations have gone to targeted under-served communities and people of color. Having provided shuttle service from bus and Metro Link transit hubs on campus, the Cal State L.A. site has been an important service to people without cars seeking vaccination.

        On a national level, the new darling of vaccination campaigns from the federal perspective are the 17,000+ retail pharmacies currently signed up as vaccine providers. Collectively, they are reported to have delivered as many as a million doses a day in March. If these numbers are correct that would make over 500 vaccinations per day per pharmacy which seems unlikely. While there are some FEMA mega sites still scheduled to open, the much smaller pharmacy sites are likely to continue to expand as demand for vaccine continues. The vaccines sent to the mega sites and the retail pharmacies are separate from the vaccines allocated to the state for distribution to local health jurisdictions and other vaccine providers.

Looking for COVID in Vaccinated Persons

        We know that the COVID vaccines in use in the U.S. are very good at preventing symptomatic COVID infection and when it occurs, it is much less severe. We are starting to get information from a variety of studies suggesting that asymptomatic infection of vaccinated persons is also low. The healthcare systems at the University of California, San Diego (UCSD) and the University of California, Los Angeles (UCLA) found dramatically lower infection rates in their fully vaccinated healthcare workers in the midst of the winter surge in California cases. A caveat is that while weekly testing was mandated for asymptomatic healthcare workers in San Diego, it was optional in Los Angeles.

        The CDC just released data from their HEROES-RECOVER study of nearly 4,000 people in 8 U.S. locations at high risk of being exposed to the virus because they are healthcare workers, first responders or others on the front lines. All participants had weekly PCR testing and 10% of the infections diagnosed were in persons who remained asymptomatic. Consistent with clinical trial data, persons ≥2 weeks out from their 2nd Pfizer or Moderna shot were 90% protected from infection.

        Within months, Pfizer and Moderna are expected to release data on infections in previously vaccinated persons with no known COVID illness prior to their vaccination. These post vaccination illnesses will be identified by detecting antibodies against the N protein of the COVID virus. These antibodies are distinct from the spike protein antibodies created in response to the vaccine.

        We can hope to get even more detailed information in a 6-month study getting underway to look for COVID infections in vaccinated college students. Those students will do daily nasal swabs along with periodic antibody tests and questionnaires to detect infection and to measure the amount of virus in the nose (the viral load) for those with new COVID infection. They also expect to follow the close contacts of those new cases using daily nasal swabs and other tests to address the important question of whether newly infected vaccinated persons can transmit the virus to their close contacts along with twelve other secondary outcomes.

        There will be an anticipated 37,500 students enrolled in the study from 21 colleges (including UCSD and Charles Drew University) in 15 states and they are anticipating up to 25,000 close contacts for evaluation.

Wednesday Funny

Adapted from: https://twitter.com/EThomasJones/status/1375072488783282181

Wednesday Funny – Anticipating Post Pandemic Anxieties


        Adapted from https://www.instagram.com/p/CMPpnmJL053/

Basic Preventive Measures

        Help more people live to see and hug their family and friends outside their household again:

  • Continue to limit your close contact to people within your household.
  • Use social distancing, wear a mask (or two), choose outside or other increased ventilation, and wash your hands.
  • Isolate/quarantine when indicated (see below).

Quick Links to Resources

Vaccine Eligibility/Appointments

  • For vaccine eligibility and appointments all over California use ca.gov – the key to success is persistence and an ability/willingness to reenter your information multiple times.
  • Kaiser has a separate state vaccination program open to non-members.
  • Remember there is no cost to you for the vaccine and eligibility does not depend on health insurance, citizenship, or documentation status.

Clinic Physician: Ann Walker, MD

COVID Update 3-24-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Getting Information in the Language Your Household Needs

        I was part of a panel presenting COVID vaccine information to students and, as usual, they had good questions. Then a student asked where they could find a Spanish translation of reliable information to assist them in discussing vaccination with their household. I was totally unprepared to answer this question.

        Another panelist was able to provide one link to the CDC website offering information in languages other than English. Reexploring the CDC website showed me that much of their information is available in Spanish, Chinese, Vietnamese, and Korean. There are also 60 other languages that can be used as a filter for finding a translation of some of the CDC’s printed information.

        If you are looking for COVID vaccine information, consider starting with their page of frequently asked questions and use the drop-down menu at the top of the page to select a language. If you open the browser window widely enough, you will also see the menu on the left of the page with a variety of topics related to vaccination, including myths and facts, information for some specific subgroups of persons, and detailed information on the three COVID vaccines that currently have emergency use authorization.

Vaccination Studies in Children

        The observation so far has been that children don’t seem to develop symptomatic COVID as frequently as adults and appear to present a lower risk of transmitting illness to adults. Some children do get ill, and a small number die of complications or develop ongoing symptoms.

        While we are months away from actionable results, Moderna has launched its vaccine trials for 6,750 children from 6 months up to age 12 years and 3,000 children ages 12 through 17. Astra Zeneca has started trials for children 6 years through 17 in Britain. Pfizer-BioNTech is testing its vaccine in children 12 years through 15 years and will move to younger ages later. J&J/Janssen will also study their vaccine in children.

An Attempt to Put Variants in Perspective

        A variant is a version of the COVID virus that contains mistakes in its genetic code compared to previous versions of the virus. Mistakes in copying the genetic code are a common event. Every new infection is an opportunity to add another mistake. Most of these mistakes make no difference in how the virus performs and some will make the virus less successful. The mistakes become a “fingerprint” for that version of the virus, allowing us to trace its origins and follow its path forward if it is successful in spreading.

        Though genomic sequencing has demonstrated innumerable genetic differences, so far there are only a few   variants of concern in the U.S. – B.1.1.7, B.1.351, P.1 and B.1.427/B.1.429. They are classified as variants of concern because they contain changes that make them more transmissible, or make infected persons sicker, or reduce the virus’ susceptibility to treatment or pre-existing immunity (from natural disease or vaccine). These variants of concern have mutations in common, even though they are not descended one from another, making them an example of convergent evolution. Dr. Vaughn Cooper, a microbiologist and molecular geneticist at the University of Pittsburgh, believes this “suggests this virus might be running out of big adaptations because they’re all basically grabbing the same handful”.

        We know that the vaccines approved in the U.S. perform against the variants of concern almost as well as they do against the original COVID virus with respect to preventing severe disease, hospitalization, and death. While we can document some drop in neutralizing antibodies for these vaccines against some variants, there are many other ways in which vaccines prepare your immune system to fight the disease. While the immunity of prior COVID infection from an older version of the virus may not prevent infection with a newer variant, the expectation is that the severity of disease would be diminished.

        Perhaps you are wondering how we can eliminate the threat of acquiring new variants of concern, or at least slow down the pace. The answer, as it always has been, is to stop the spread of the virus. The tools we have to accomplish this are the combination of widespread vaccination, along with continued masking, distancing, and avoiding poorly ventilated spaces.

Thoughts on the Future of SARS-CoV-2

        It started with a depressing article about five reasons why COVID herd immunity is impossible. Digging into the background materials revealed a more hopeful interpretation: that failure to eradicate COVID does not have to mean that we continue with the same level of illness, death, and social distancing/disruption. Even if we cannot eradicate COVID, we may be able to convert it from a pandemic disease to an endemic disease, similar to influenza and the common coronaviruses that cause the common cold. Previously acquired immunity and re-tooled vaccines when necessary may allow societies to tolerate seasonal illness and a diminished number of deaths without lockdowns and distancing. Maybe we ought to be more impatient with the ~650,000 deaths worldwide from influenza each year (without extensive lockdowns) but we can all agree that the total of 2.7 million deaths from COVID worldwide over the past year (even with lockdowns, distancing, masking, and severe disruptions) is intolerable. Here’s an algorithm of several factors and how they can combine to produce a variety of evolving outcomes, mostly far better than our current condition:

        Adapted from: https://www.nature.com/articles/d41586-021-00396-2

        One of the recurring take-home messages is that the tools of masking, distancing, and vaccination are within your control. These measures will help reduce transmission and therefore reduce the burden of disease.

Wednesday Funny

        Adapted from: https://www.instagram.com/citycyclops/

Basic Preventive Measures

        Help more people live to see and hug their family and friends outside their household again:

  • Continue to limit your close contact to people within your household.
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes.
  • Isolate/quarantine when indicated (see below) and wash your hands.

Quick Links to Resources

Vaccine Eligibility/Appointments

  • For vaccine eligibility and appointments all over California use ca.gov – the key to success is persistence and an ability/willingness to reenter your information multiple times.
  • Kaiser has a separate state vaccination program open to non-members.

Clinic Physician: Ann Walker, MD

COVID Update 3-17-2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.  

COVID Vaccine Eligibility Extended to Chronic Medical Conditions 

California and L.A. County extended vaccination eligibility to persons 16-64 years old with qualifying medical conditions or disabilities as of 3/15/2021. The L.A. County vaccine allocation page now also provides links for the required documentation for each group of persons eligible for vaccine. 

For persons eligible on the basis of a qualifying medical condition or disability those requirements include: 

  1. Photo ID (does not have to be government issued) 
  1. Proof that you live in L.A. County if your other documents do not include your home address (click on “list” for a pop-up box of acceptable items) 
  1. Self-attestation that you have a high-risk medical condition or disability 
  • Self-attestation fillable form is available 
  • It is acceptable to write out the applicable self-attestation (e.g., “I have a medical condition or disability that makes me eligible for COVID-19 vaccine” with your signature, printed name, and date) 
  • In keeping with privacy laws, you do NOT need to specify the medical condition or disability 

You do NOT need to be a U.S. citizen to get a vaccine. 

A New Test for Prior COVID and Maybe More 

Adaptive Biotechnologies in Seattle has been given an emergency use authorization for their T-Detect COVID test that looks for signals of past COVID illness. When the immune system responds to a viral illness the T cells develop receptors that are ready to bind to multiple parts of the virus that caused the illness. While antibodies generated in response to that same infection normally diminish in numbers following the resolved infection, the T cells and their disease specific receptors persist. Studying the T cell DNA of many people after COVID illness has made it possible to identify numerous T cell receptors that are specific for COVID.   

     The algorithm is currently focused on the yes/no question of whether an individual has experienced COVID. The test is reported to be 97% sensitive and 100% specific. With time and further research, this process may also be able to untangle some of the mysteries of long-haul COVID and provide an assessment of the efficacy and durability of the immune response elicited by vaccines.

Should We Share the Vaccines We Have But Aren’t Using? 

When the race to make a COVID vaccine started, the U.S. made financial investments in several companies, locking in orders for vaccines if they proved effective. The contract with Astra Zeneca was $1.2 billion in return for 300 million doses. The Astra Zeneca viral vector vaccine has been in wide use with emergency authorizations in Europe, Asia, Africa and Australia as well as Canada and South America. In the last week, many countries have put the use of the Astra Zeneca vaccine on pause while investigating clotting problems in vaccine recipients. This step has been described as a precaution with wide acknowledgement that the frequency of clotting problems in vaccine recipients has not exceeded the rate seen in the general population. The European Drug Agency (Europe’s main drug regulator) and the World Health Organization have both said there is no causal link between the vaccine and these events and that the vaccine’s benefits outweigh any risks. 

Meanwhile, the Astra Zeneca phase 3 trial in the U.S. is set to be completed in April and is expected to have an overall efficacy that clearly exceeds the FDA requirements for approval. Manufacture of the Astra Zeneca vaccine in the U.S. means that some 30-40 million of the 300 million doses promised are already in storage in the U.S. Astra Zeneca has asked the Biden government to let it loan those doses to the European Union or Brazil where outbreaks are raging and Astra Zeneca has fallen short of its original supply commitments. These redirected doses could be replaced later when/if the Astra Zeneca vaccine is approved in the U.S. 

The U.S. has said no. Current projections of vaccine availability in the U.S. suggest there may be more than a billion doses by the end of 2021, with most of those doses available by summer. That is far more doses than would be needed to vaccinate the entire U.S. population even with counting children and adolescents for whom the vaccines are not yet approved. 

Caution on the part of the U.S. is on some levels understandable. Vaccine production can be complicated and unexpected problems can take plants out of production. At the same time, those millions of doses of Astra Zeneca only have a 6-month shelf life and their clock is ticking. The U.S. has agreed to provide financial support for a major vaccine manufacturer in India to produce at least 1 billion doses of vaccine by the end of 2022. This will help address the global vaccine shortage but that is months to a year away and the need for vaccines around the world is now. One Campaign, a nonprofit dedicated to ending world poverty, has called on the Biden administration to share 5% of its doses when 20% of Americans have been vaccinated followed by gradually increasing the percentage of doses shared as more Americans are vaccinated. As of early 3/16/2021, 15.1% of Americans ≥18 years old have been fully vaccinated.  

An Embarrassment of Riches? 

The U.S. appears to be headed towards having yet another highly effective COVID vaccine soon. Novavax was given $1.6 billion by the U.S. government in exchange for a promise of 100 million doses if their vaccine proved effective. The Novavax vaccine is made of nanoparticles of COVID spike proteins and would be the third class of vaccine in the U.S. if approved. The U.S. and Mexico phase 3 trials are due to conclude in April. The data from the Novavax phase 3 trial in the United Kingdom showed an overall efficacy of 96% against the original version of the coronavirus and an efficacy of 86% against the more contagious B.1.1.7 variant. A smaller phase 3 trial in South Africa conducted when the B.1.351 variant predominated had 55% efficacy in participants without HIV while still fully preventing severe disease.  

Wednesday Funny 

Adapted from http://mchumor.com/daylight-saving-time-cartoons-pg1.html 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 3-10-2021   

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

A Partial Taste of Freedom for Fully Vaccinated People 

The CDC published interim public health recommendations for fully vaccinated people. Those people may visit other fully vaccinated people indoors without wearing masks or distancing. They may also visit a single unvaccinated household without masks and distancing if everyone in that household is at low risk of severe COVID. If the gathering includes more than one unvaccinated household then the participants should wear masks and maintain social distance, and the event should take place outdoors or in a well-ventilated space. 

These fully vaccinated persons are also exempt from quarantine following close contact with a COVID case assuming the fully vaccinated person remains asymptomatic. The benefits of reducing social isolation and relaxing quarantine requirements are felt to outweigh the residual risk of fully vaccinated persons becoming ill with COVID, and the even smaller theoretical risk of transmitting COVID to others. It is also hoped that the relaxed restrictions may help improve COVID vaccine acceptance and uptake. There is more detailed guidance for residents and employees of non-healthcare congregate settings and high-density workplaces. 

More on the Variants 

In a version of “Pokemon, gotta catch ‘em all”, Houston, Texas is the first city in the U.S. to document all of the recent COVID variants of concern (B.1.1.7, B.1.351 and P.1) and the U.S. variants of interest (B.1.526 and B.1.427/B.1.429). The extra step that Houston has taken is to collect detailed demographic and health information on the infected patients and connect that information to the variant detected. This patient data will help move our knowledge from inference to objective observations about transmissibility of variants, the severity of disease caused by variants, the response of variants to monoclonal antibody treatment and the ability of variants to evade immunity from prior illness and vaccine. Iceland and Israel appear to be collecting similar data. 

The U.S. has capacity for a significant amount of genomic sequencing at a variety of institutions, but there have been barriers to connecting that capacity with samples and data. In early February, the U.S. ranked 36th in the world in sequencing SARS-CoV-2 cases with a rate of 0.36% of confirmed cases. The highest rate was in Hawaii at 2.6%, the lowest states were at 0.02%. California clocked in at the U.S. average. For comparison, Denmark leads the world, sequencing over 50% of its confirmed cases. 

In mid-February, $1.6 billion was pledged in the U.S. to improve testing access for schools and homeless shelters, which included support for the manufacturing of testing supplies. Some $200 million of that pledge is to fund increased sequencing and is considered a down payment on funding in larger $1.9 trillion COVID-19 relief bill that is now poised to pass. Some suggest that it will take $2 billion to increase sequencing to 15% of confirmed cases in the U.S. 

If you are curious about variants identified in California, the California Department of Public Health publishes data every Thursday. The New York Times coronavirus variant tracker provides updated information on variants of concern, variants of interest, and the nature of the individual mutations that are involved in these variants. 

The Mystery of Long-Haul COVID 

The NIH is launching a 4-year study of long-haul COVID symptoms with $1.15 billion allocated by Congress. The NIH calls this condition “Post-Acute Sequelae of SARS-CoV-2” (PASC). It encompasses long-lasting symptoms of fatigue, fever, headache, shortness of breath and “brain fog” which range in severity from mildly annoying to incapacitating. 

There are anecdotal reports of partial improvement to full resolution of PASC symptoms following COVID vaccination. The lack of comparison groups and long-term follow-up mean there is no definitive data regarding how many PASC patients may experience relief, how long it lasts, and whether the improvement is linked to vaccination. As Dr. Stanley Weiss, an infectious disease specialist and epidemiologist at Rutgers New Jersey Medical School says, “the way you progress in science and medicine, is that you take observations from astute observers and pursue them with scientific rigor.” 

Long-Haul COVID Symptoms after Mild and Asymptomatic COVID 

It was sobering to read about the >75% prevalence of persistent symptoms 6+months after hospitalization for some 1,700 COVID patients in Wuhan, China. Now there is a study of 1,400 COVID patients in California, identified through a review of electronic medical records, none of whom were ill enough to be hospitalized, but 27% of whom are struggling with long-haul COVID at 2 months and more after their illness. Their symptoms include shortness of breath, chest pain, cough, and abdominal pain. It is troubling that of the 34 children identified with a history of COVID that did not require hospitalization, eleven were found to have long-haul symptoms. Also striking, nearly a third of the long-haul patients had been entirely asymptomatic during their initial COVID illness, identified as COVID cases by testing alone.  

Wednesday Funny 

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/03/house-cat.jpg 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

  • If you are looking for a test because you had close contact with a suspected/confirmed case, you need to quarantine: ph.lacounty.gov/covidquarantine (instructions changed 12/17/2020) 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 3-3-2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.  

Education Sector Employees and COVID Vaccine 

     Being eligible for vaccine and finding an available appointment will continue to be two different things for a while. Checking availability frequently is the best advice we can give. Those “access codes for educators” you may have heard about appear to be for K-12 only. The campus will continue to share any reliable information received as soon as possible. See the links below for state and Public Health Department vaccine information and see the 2-24-21 COVID Update for links to pharmacies. 

Dramatic Decline in Nursing Home Cases and Deaths 

During most of the pandemic, a nursing home was a dangerous place to live or work. Residents and employees represented more than one-third of all COVID deaths since late spring 2020. Since COVID vaccination started in late December, the cases and deaths have been falling faster in nursing homes than the general population. The turnaround is an encouraging sign of vaccine effectiveness. Knowing that only half of the vaccinated residents and employees have been fully vaccinated gives reason to hope that a first dose of vaccine may offer more protection than previously thought. Clearly, some of the improvement is due to falling community transmission rates, but that would not explain the improvement in nursing homes clearly outpacing that in the general population. 

Yes, I Would Take That J&J Vaccine with No Hesitation 

The J&J (Janssen) viral vector COVID vaccine (Ad26.COV2.S) got its Emergency Use Authorization (EUA) from the FDA last week and it is a welcome addition to the growing number of effective vaccines. The data is impressive, with overall efficacy of 72% in the U.S. and 64% in South Africa, where the B.1.351 variant has been a factor during vaccine trials. Coupled with the 82-86% efficacy of preventing severe disease and easier storage requirements, the J&J vaccine becomes a valuable addition to combating the pandemic. Before you judge this vaccine harshly in comparison to Pfizer and Moderna, read about its soon to be completed “Ensemble 2” phase three trial in the next section titled “Plans for Vaccine Tweaking in Response to Variants.” 

Plans for Vaccine Tweaking in Response to Variants 

The good news is that the vaccines with EUA approvals in the U.S. (Pfizer, Moderna and now J&J/Janssen) are still considered effective against the variant virus strains we know about so far, even when that efficacy is lower than experienced with older COVID strains. Like many vaccine manufacturers, these companies are already working on their next generation response to the variant strains. 

For Pfizer and Moderna, there may be three options to study. The simplest is to give a third dose of the first-generation vaccine to see if that increases the antibody response into an overwhelming force. Pfizer and Moderna have both submitted plans to make a second-generation vaccine to target the B.1.351 variant. These re-tooled vaccines could be given to people who have already completed their initial vaccine series, and they could also be given as their own series for persons with no prior vaccine. 

The FDA has said it will authorize the study of these three approaches based on small clinical trials and expects to evaluate their performance based on how well they prime the immune system. This represents using “correlates of protection” to predict performance. There are ongoing studies to define these correlates in terms of binding and neutralizing antibodies, as well as immune memory cell response to vaccines. Even with correlates of protection to simplify and condense the evaluation process, it will be months before there are outcomes to announce. 

Even though it was first approved for use in the US last week as a single dose vaccine, J&J has a phase three trial of a 2-dose vaccination regimen that may yield results by July. This trial includes participants from nine countries, including some where the B.1.351 variant and other variants of concern are known to exist. Data from earlier phases of this trial suggests that the 2-dose approach may triple the antibody levels produced. This may move the overall efficacy of the J&J vaccine closer to the overall efficacy of Pfizer and Moderna and could diminish the J&J performance gap with B.1.351 and other variants. 

Variants and How We Name Them 

It’s easy to be overwhelmed with the flow of new information about the SARS-CoV-2 virus and the prevention and treatment of COVID-19. Keeping track of the virus variants is one corner of this information overload. It doesn’t help that the words “variant”, “mutant” and “strain” are used almost interchangeably; for simplicity, let’s stick with “variant”. 

When a particular variant is found with increasing frequency, it becomes a “variant of interest” (VOI). If a VOI is found to have increased transmissibility, increased mortality, decreased detection by diagnostic tests, ability to evade natural or vaccine produced immunity, or any other characteristics to make it more worrisome, it is called a “variant of concern” (VOC). 

There is no globally-agreed method of naming these variants. The PANGOLIN system (Phylogenetic Assignment of Named Global Outbreak Lineages) gives us names like B.1.1.7, B.1.351, P.1, B.1.427, B.1.429 and more. Those last two represent variants of interest discovered in California when searching there for B.1.1.7.  

Nextstrain is an open-source project collecting all publicly-available genomic sequencing information to aid epidemiologic understanding and improve outbreak response. That system gives us names like 20I/501Y.V1 (aka B.1.1.7), 20H/501Y.V2 (aka B.1.351) and 20J/501Y.V3 (aka P.1). Nextstrain does not assign a distinct name until a clade reaches ≥20% of global frequency for 2 months, or ≥30% of regional frequency for 2 months or becomes a variant of concern. A clade is a group of organisms believed to have evolved from a common ancestor.  

You may have noticed that the words “British”, “South African” and “Brazilian” have not been mentioned. Labelling a variant by where it was first identified makes an easy handle, but it is problematic. Naming variants and viruses according to their alleged country or demography of origin has historically proven effective at generating misinformation and prejudice. It is a small step in the human brain looking for shortcuts to think of those geographic locations as being part of the “problem” and developing implicit bias associated with these locations, rather than thanking those locations for doing enough genomic sequencing to detect the emerging variant. I am guilty of using the geographic names to refer to the variants because they were easy to distinguish, remember and use; almost everybody is familiar with world geography. I will switch to the PANGOLIN system for all the reasons stated above. 

Wednesday Funny 

-Be the one who interrupts transmission 

by staying out of the line of fire- 

Image adapted from https://mashable.com/article/matches-coronavirus-social-distancing/ 

 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 2/24/2021  

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

Links Posted by Pasadena Public Health for Vaccines Through Pharmacies as of 2/22/2021 

Rite Aid: https://www.riteaid.com/pharmacy/covid-qualifier 

Vons: https://www.vons.com/pharmacy/covid-19.html 

Pavilions: https://www.pavilions.com/pharmacy/covid-19.html 

Ralphs: https://www.ralphs.com/rx/guest/get-vaccinated 

CVS: https://www.cvs.com/immunizations/covid-19-vaccine 

Walgreens: https://www.walgreens.com/topic/promotion/covid-vaccine.jsp 

Some of the Recent Entries in the Parade of Changes 

Pfizer has submitted new temperature data to the FDA that would allow up to 2 weeks storage at standard freezer temperatures. This would significantly expand the number of vaccination venues able to use the Pfizer vaccine. 

The L.A. County and California Public Health Departments have adopted the new CDC recommendations that fully vaccinated persons exposed to COVID do not need to quarantine if:  

  • it has been ≥2 weeks since their final dose; 
  • it has been <3 months since their final dose; 
  • they have remained asymptomatic since the exposure. 

The FDA has proposed guidelines for reviewing changes that vaccine manufacturers may choose to make in their already EUA approved vaccines to respond to new variants of COVID. It includes trials that can be completed more quickly and with fewer participants than the original vaccine phase three trials because they can make use of correlates of protection which are still being determined. This is a common approach for updating other vaccines when needed. There are multiple variables that will affect when these vaccine changes may be needed.  

What Goes Around, Comes Around 

We are reasonably confident that the novel coronavirus causing COVID started in bats and infected humans when a version evolved that could not only survive but thrive in humans. This makes the COVID virus a zoonosis. The reverse is anthroponosis – when an illness passes from people into animals. There is already documentation of COVID in farmed minks, and lions and tigers in zoos, all thought to have occurred as a result of contact with infected humans. Despite taking precautions to prevent it, the San Diego Zoo Safari Park discovered that several gorillas were sick with COVID in January. There is also evidence that the COVID virus can infect deer, mice, and several other animals in the wild. The broad range of species that can be infected increases the chance of creating a “sylvatic cycle” with the virus circulating (and evolving) endlessly in wild animal populations, then spilling back into humans when circumstances may allow. Those circumstances may be as simple as someone sweeping up dust laced with mouse droppings in a garden shed, or a hunter dressing out a dead animal. 

Manaus, Brazil as a Cautionary Tale 

Manaus, Brazil is a metropolis of 2+ million people on the banks of the Amazon river that had a devastating number of COVID infections in April and May 2020. Distancing and masking brought the numbers down and did not increase as restrictions were lifted from July to November. The best estimate was that 76% of the population had already been infected so everyone was surprised when another devastating wave of COVID illness and hospitalizations began in January 2021. 

According to the Lancet, there are at least four factors that could explain the resurgence of COVID. The extent of prior COVID illness could be smaller than estimated. The 8 months between April and December could have reduced antibody levels in previously infected persons, even though we think memory B and T cell function lasts longer. The current surge of infections could represent a more transmissible COVID variant. Early data suggests that the Brazil variant, also known as P.1 or B.1.1.248, is becoming dominant in Manaus. Finally, the current surge may represent mutations in the Brazil variant that help it escape control by the antibodies developed in response to older versions of COVID.  

Manaus is a tale of what can happen anywhere that has no protection against the more transmissible variants coupled with mutations to dodge the antibodies of older COVID infections. The basic nature of evolutionary biology is that the virus should be expected to continue to evolve in ways that circumvent our defense mechanisms. Using global distribution of effective vaccines will be essential to bring down rates of transmission as quickly as possible to choke out the development of variants that are even harder to manage. 

Wednesday Funny 

 

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/05/cats-and-dogs.jpg 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 2-17-2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

Vaccine Availability in L.A. County 

The field of choices has expanded recently to include the FEMA/CalOES site at Cal State L.A. that started vaccinating on 2/16/2021, the CVS and Walgreen pharmacies that started vaccinating on 2/12/2021 and the yet to be announced California Federally Qualified Health Center offering COVID vaccine funded by the federal Health Resources and Services Administration. All three of these new vaccination avenues say they won’t cut into the allocations to the state of California though that doesn’t answer the question of why many vaccination sites across L.A. have been limited to 2nd doses over this week and the last with only 4,600 doses earmarked for first doses at Pierce College and mobile clinics in hard hit South and East L.A. 

In order to get a dose at Cal State L.A., the state suggests that you go to myturn.ca.gov though it appears that some churches, social service agencies and other groups will be allocated group tickets for a portion of the vaccines (does this mean that the 2 mobile clinics attached to the Cal State L.A. site will go to those groups?). 

Appointment information for the pharmacy vaccination sites can be accessed through CVS.com, the CVS smartphone app or 800-746-7287 for CVS and Walgreens.com/ScheduleVaccine for Walgreens. Both pharmacy chains will make appointments for your first and second dose at the same time. So far, CVS and Walgreens are the two pharmacy chains participating at a variety of locations in CA. Do not call the individual stores; use the pharmacy websites and other scheduling tools. CVS says new appointments are added daily. 

Dodger Stadium and other L.A. County vaccination sites got back into the game this week though, like last week, their appointments are primarily for second doses with vaccine held back for that purpose. Pasadena Public Health does not have vaccine to give first doses this week and have second doses only for persons who got their first dose from them earlier. If you are a healthcare worker living or working in Pasadena or someone 65+ living in Pasadena looking for a first dose and can show up on 30-60 minutes notice they suggest that you join their “On-Call” list.  The good news is that Newsome expects the state’s allocation for this week to be 1.28 million doses and 1.31 million doses next week. If that is true, why does L.A. County with one fourth of the state’s population of residents 18+ years old only have 4,600 doses for first vaccinations this week? 

COVID Vaccines and Children 

Pfizer will be testing children 12 through 15 and Moderna will be testing children 12 through 17 in clinical trials of their vaccines with results expected in mid-2021.  

These trials are small with some 3,000 participants and because of those low numbers and the lower incidence of COVID infection (and especially severe COVID) in this age group, efficacy will be based on measuring the strength of immune response in these children rather than using infection with COVID as an endpoint. Moving on to children 6 months through 11 years would be a separate study with possible modifications of dosing and schedule. 

If you have a child currently too young for COVID vaccine, consider using the time waiting for more information to catchup on routine childhood vaccinations which have gone AWOL at a higher than usual rate during the pandemic.  

Not Too Early to Think About the Next Novel Coronavirus 

Researchers are starting to develop prototypes of a so-called pancoronavirus vaccine. When the coronavirus was discovered in the 1960’s, no one was interested in vaccine research because all it seemed to do was cause mild head colds. When the first novel coronavirus created SARS (Severe Acute Respiratory Syndrome) in 2002 and the second resulted in MERS (Middle Eastern Respiratory Syndrome) in 2012, there was discussion but no research funding for a SARS and MERS pancoronavirus vaccine. Though both were more lethal than COVID, neither became widespread before they went dormant and attention turned to Ebola and Zika viruses. 

Last month, Paula Bjorkman, a structural biologist at Caltech, and colleagues showed that a vaccine made from the spike tips of eight different coronaviruses generated effective antibodies in vaccinated animals not only for those eight coronaviruses but also for four other coronaviruses not in the vaccine.  

Another strategy may be to look at the vast array of antibodies made during a coronavirus infection in hopes of finding the rare antibody that works against a range of related strains and develop a vaccine to promote production of a broadly neutralizing antibody. Either approach is likely to be better than crossing our fingers and hoping we don’t get fooled again. 

Finally, Some Data on Sputnik V 

Russia drew criticism from many when it approved its 2-dose Sputnik V viral vector vaccine for use in August 2020 before phase 3 trials had begun. Those concerns are largely answered with the publication of results in The Lancet showing the vaccine to be safe with an overall efficacy of 91% and a 100% efficacy for preventing severe disease. This puts it on par with the Pfizer and Moderna vaccines. 

The price of $10 per dose and storage requirements, no worse than normal freezer temperatures, make it a useful addition to world vaccination options. The drawbacks are that it is more difficult to mass produce and the Moscow based phase three trials lacked ethnic diversity to ensure equivalent performance in non-white recipients. A trial with a more diverse study group is underway in the United Arab Emirates and it will also be important to know how it performs against the South African viral variant that has been a stumbling block for so many other vaccines.  

Wednesday Warm and Fuzzy 

Bats have acquired a lot of PR baggage over the past year as the presumed origin of the SARS-CoVG-2 virus. Maybe watching the story of Statler the geriatric fruit bat and the cross-species empathy of the humans responsible for his care will provide a new perspective. 

See Statler’s story at: https://www.youtube.com/watch?v=mC8mZuYNSFs 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 2/10/2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

Maybe Not the News You Want, But There is Some Good News on Vaccines 

PCC’s request with CalVax for vaccine is still pending. The overall reorganization of vaccine distribution from the state level, the opening of mass vaccination sites, and the distribution of vaccine to pharmacies, likely mean that we will continue to wait. As of 2/9/2021, both L.A. County DPH and Pasadena PHD are still offering vaccine only to persons in phase 1a and those 65+ years old.  

     The good news? As of 2/9/2021, the total number of doses of vaccine administered in L.A. County (1,221,515) exceeds the total number of confirmed cases in the county (1,152,430); daily vaccine doses administered is up to ~40,000. 

Does the British Variant Raise the Risk of Dying? 

Preliminary data from the British government suggests the more easily transmissible B.1.1.7 COVID variant may be as much as 35% deadlier. It isn’t clear whether the increased deaths being counted mean that the virus is deadlier or just that it is spreading faster and reaching greater numbers of vulnerable people. The preliminary information does not provide statistics about underlying conditions like diabetes and obesity that can contribute to the risk of death from COVID.  

How Plunging Case Numbers May Only Be the Calm before the Storm 

The rise and fall of case numbers in Denmark should be a cautionary tale for L.A. County. Denmark hit a peak of 3,000 cases/day in mid-December 2020 and is down to just a few hundred now due in part to far reaching lockdown measures. Their disease modelers warn that genomic sequencing shows they have two epidemics, one that is shrinking fast caused by older variants of the virus and a currently growing epidemic of infection caused by the British variant B.1.1.7. That variant represented 0.5% of all COVID cases in early December and is up to 13% of all cases by late January 2021. Denmark has this information because they have a virus sequencing effort that is massive compared to the U.S. 

L.A. County’s 7-day average of daily cases was over 15,000 in early January. It’s a relief to be at “only” 5,000 now. The small amount of gene sequencing we do tells us that infection caused by the B.1.1.7 variant is already in L.A. County. As the proportion of cases with the more easily transmissible B.1.1.7 rises, our new cases per day could quickly rise again. 

Evidence to Support Getting the Vaccine Even If You Have Already Had COVID 

Some 30% of the participants in Novavax’s South African phase 3 trial have already had COVID. In the placebo group of that trial, participants with a prior history of COVID appeared just as likely to become infected as the participants with no prior COVID illness. It had been hoped that prior illness would help prevent reinfection but that may not be true for the B.1.351 COVID variant that has recently dominated disease in South Africa.  

There is a limit to the conclusions that can be drawn from this observation because the vaccine trial was not designed to address the question of reinfection. While prior COVID did not appear to prevent reinfection with the B.1.351 strain, the rare occurrences of severe COVID reported so far is good news.  

More Data on the B.1.351 Variant 

Preliminary Astra Zeneca results from a small trial in South Africa suggest that their vaccine may be no more than 10% effective at preventing mild to moderate COVID illness there where the B.1.351 strain is so prevalent. With only 2,000 participants in the trial, it is unlikely they will have the statistical power to detect a meaningful difference in the rarer occurrence of severe COVID. This is disappointing news for South Africa which just took delivery of a million doses of Astra Zeneca vaccine to begin vaccination of their healthcare personnel. Astra Zeneca has started work retooling their vaccine to make it more effective against this strain, but it may not be available until fall 2021. 

A Link to Many Helpful FAQs 

Sometimes it is hard to know what people want to know. The New York Times has an evolving list of COVID vaccine FAQs that are aimed at the general reading public with links to more information when desired. The only correction I would make is to say that while someone who has had COVID may choose to delay vaccination for up to 90 days after their illness, as long as they were not treated with monoclonal antibodies or convalescent serum, the only delay they must observe, is to wait until they are off isolation based on CDC guidance (scroll down to “Vaccination of persons with a SARS-CoV-2 infection or exposure”). Also, delay until off quarantine if you have been exposed. The point is to avoid exposing the people who are vaccinating you. 

Wednesday Funny 

Adapted from https://www.shielltoons.com/wanderingmelon  

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

If you haven’t tried it, take a look at www.myturn.ca.gov if you are searching for vaccination. If you aren’t eligible yet, you can ask to be notified when you become eligible in your area. Vaccine allocation information for individual Public Health Departments can also be found at these links: 

Clinic Physician: Ann Walker, MD 

COVID Update 2-3-2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

What We Know About COVID Vaccine for PCC 

PCC’s CalVax application to administer COVID vaccine has been approved. An initial request for vaccine has been made but there is no way to know if or when it will be filled. Vaccine allocation in response to requests occurs on the state level; it is now under the direction of Blue Shield and remains highly constrained. In Pasadena and L.A. County, vaccine eligibility through Public Health continues to be limited to Phase 1a (healthcare workers) and persons 65+. If any vaccine is allocated to PCC, it will be the Moderna vaccine based on storage requirements. See the links at the bottom for vaccine eligibility for Pasadena, Long Beach, and the following counties: L.A., Orange, San Bernardino, and Riverside.  

Efficacy for Novavax 

Novavax reported a 90% efficacy for their 2-dose protein vaccine in their U.K. phase 3 study compared to 49% in their South Africa phase 3 study (up to 60% if you exclude the 6% of participants with HIV). The U.S. Phase 3 trial did not start until late December 2020. Novavax may wait to apply for an Emergency Use Authorization in the U.S. and the FDA may decline to consider the same until that U.S. phase 3 trial data is available. 

Putting the Johnson & Johnson Results in Perspective 

The overall efficacy of the J&J one-dose viral vector vaccine for the prevention of moderate and severe COVID disease was reported by the company at 72% in the U.S., 66% in Latin America and 57% in South Africa. The more crucial measure with respect to reducing mortality may be the 85% efficacy at preventing severe disease that was found in all three locations. 

It is important to remember that Pfizer and Moderna with overall efficacies at 95% and severe disease prevention of almost 100% did their phase 3 trials before the variant strains became as widespread. If you were offered the J&J vaccine today versus the Pfizer or Moderna in 3 weeks, should you hold out? “No”, says Dr. William Schaffner, an infectious disease expert at Vanderbilt University. He reasons that the virus is bad and holding out for a higher efficacy vaccine risks more exposure with the delay in protection. 

Guaranteed to Make You Reach for Your Mask 

The COVID virus variants from Britain, Brazil and South Africa are three genetically distinct, distantly related branches of the SARS-CoV-2 family tree. They have independently acquired some of the same mutations despite emerging on 3 different continents making them an example of convergent evolution. There is too much genetic dissimilarity to suggest that their presence is a function of spread by travel of infected people.  

These mutations all occur in the receptor binding domain (RBD) of the COVID spike protein, the part that binds to Angiotensin Converting Enzyme 2 (ACE 2) receptors on human cells. That binding allows the RNA of the virus to invade the cell and put it to work making copies of the virus. All three variants have the N501Y mutation which appears to make it easier for the spike protein to grab the ACE 2 receptor, increasing transmission of the virus. The Brazilian and South African variants also share two other mutations. One of these mutations, E484K, not only promotes tighter binding of virus to the ACE 2 receptor but also makes the virus ten times less vulnerable to neutralization by antibodies in the blood of recovered COVID patients. 

SARS-CoV-2 has been circulating in bats for millions of years. The ACE 2 receptors of bats have been under evolutionary pressure to thwart the attack of the virus which has undoubtedly contributed to the wide genetic diversity of ACE 2 receptors in bats. Increasing diversity of ACE 2 receptors in bats favored on-going mutations in the SARS-CoV-2 virus, including a viral variant that could bind with human ACE 2 receptors, facilitating the cross species leap via an intermediate host we have yet to identify. 

From another perspective, the enormous number of ongoing COVID infections around the world translates into more opportunities for SARS-CoV-2 to mutate, increasing the opportunity for more dangerous mutations to emerge. We cannot evolve our way to less susceptible ACE 2 receptors in a meaningful time frame. Vaccines can help reduce the total load of COVID infections and Moderna is already retooling their mRNA sequence to address these challenging variants. Even so, we will continue playing catch-up if we can’t use a heavy enough hammer of distancing and masking to dramatically reduce the number of cases and the subsequent opportunities for further mutation of the virus. 

Why You Want Lots of Shots on the Vaccine Goal  

If you had been inclined to place bets in the spring of 2020 regarding successful COVID vaccine development, it would have made sense to bet on Merck. They have been making vaccines for a long time. Moderna and Novavax would have been long shots as newbies at vaccine manufacturing. Today, Moderna has an Emergency Use Authorization and Novavax seems poised to do the same while Merck pulled both of its vaccine candidates on 1/25/2021 because of underwhelming immune responses in phase 1 trials. 

The world needs multiple successful vaccines and while Merck won’t be making one, they can turn more of their attention to their candidates for treatment of COVID, such as molnuprivar, an oral antiviral in phase 2/3 trials and MK-7110, a new approach to halting the immune system response to COVID when it turns harmful. Interim phase 3 results show a 50% reduction in the risk of death and respiratory failure in patients with moderate to severe COVID. 

Wednesday Funny 

 

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/03/cvs-receipts.jpg 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

Vaccine Eligibility Information 

Clinic Physician: Ann Walker, MD 

COVID Update 1-27-2021

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.

Are You Feeling Confused About Who is Eligible for COVID Vaccine?

Join the club. The rules of the road keep changing before the ink is dry. The best you can do is keep checking the L.A. County and Pasadena vaccine allocation links at the end of this update. The L.A. Times reported that the state is looking at shifting to vaccine allocation on the basis of age rather than occupational risk. Pasadena Public Health will be running another drive-thru COVID vaccination clinic on 1/28/2021 but if you don’t have an appointment from them, don’t go – they already have their standby list of eligible persons in case there is left-over vaccine. The campus will continue to pass along actionable information on vaccination as it becomes known.

Don’t let the lifting of “Safer-at-Home” make you think it’s a safe world out there. It is true we were averaging 15,000 new cases a day at our peak and we are down to ~10,500 per day but we will likely need to be below ~2,500 cases/day to move from purple to red even with some relaxed guidelines that have been proposed. It’s great to have a test positivity rate of 12-13% when we were at 21% until you recall we were at 3.4% in early November.

On the Verge of a Game-Changing Vaccine?

Johnson & Johnson’s phase 3 trial of their one dose viral vector COVID vaccine started in September 2020 and is due to conclude in 1-2 weeks. Early information shows that 90% of vaccinated participants produced neutralizing antibody, something that happened in only 60% of Pfizer and Moderna participants after their first dose. If J&J’s one dose is even moderately effective it could become the vaccine of choice for the world. When facing an epidemic, the ability to protect people with the least effort is a huge advantage.

J&J hedged its bets by also starting a second phase 3 trial in November using 2 doses given 57 days apart.

Even a 50% Effective COVID Vaccine Could be a Game-Changer

Sinovac’s 2-dose killed virus vaccine, CoronaVac, has an efficacy of 50.4% based on the latest data which is underwhelming compared to the 95% efficacy of Pfizer and Moderna. What you need to consider is that CoronaVac’s safety data looks good and that side effects appear to be few and mild. While up to ~50% of vaccinated persons become infected with COVID, severe COVID illness appears to be eliminated for vaccinated persons. For any country with a raging outbreak, this would be a very good outcome.

If the Morality of Vaccine Distribution Doesn’t Move You, Maybe the Economics Will

The International Chamber of Commerce can tell us that equitable distribution of COVID vaccines is in every country’s economic self-interest. At the extreme, if wealthy countries fully vaccinated by mid-2021 and poor countries were largely shut out, the loss to the global economy would exceed $9 trillion. In the more likely scenario of wealthy countries vaccinating half their population by the end of 2021, the economic loss would be $1.8-$3.8 trillion, with half of that loss in wealthy countries. A continuing pandemic in poor countries will likely be worst for industries that are especially dependent on suppliers around the world (think automotive, textile, construction and retail). Of the $18 trillion worth of goods that were traded last year, “intermediate goods” (parts shipped to be put in other products) represented $11 trillion.

Biden has reinstated the American ties with the World Health Organization (WHO) and has stated an intention to join Covax. Covax was formed by the WHO to provide innovative and equitable access to COVID vaccine around the world. Ultimately, purchasing vaccines for the developing world is not an act of generosity by the world’s richest nations. It is an essential investment for governments to make to revive their domestic economies.

It seems reasonable to assume that the economic effects of vaccination access between the “haves” and the “have-nots” on the international level will also be seen on the national, state and local levels.

Some More COVID Vaccine FAQs

What if there are long term effects of the vaccine we don’t know about yet?

Safety data has been collected ever since phase 1 clinical trials began in March 2020 for Moderna and April 2020 for Pfizer and will continue to be collected on trial participants for years to come. Historically, ill-effects of vaccines, especially when given in large numbers, tend to show up within months. At the same time we know that many persons continue to have significant residual symptoms and pulmonary deficits after their COVID illness and we do not yet know if or when those issues will resolve.

Do I need the vaccine if I have already had COVID?

Yes. While we think infection makes you immune, we don’t know how long it lasts. While re-infection with COVID is rare, it does happen and we hope the vaccine can prevent reinfection. If you got treated with monoclonal antibodies or convalescent serum, then you should wait 90 days after those treatments to vaccinate.

Wednesday Funny


It reminds me of how our COVID case rate is past its recent peak – except L.A. County has more houses that can still burn.

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/05/fire-passed-peak.jpg

Basic Preventive Measures

Help more people live to see and hug their family and friends outside their household again:

Continue to limit your close contact to people within your household.

Use social distancing, wear a mask (or two), and choose outside or other increased ventilation when you leave your house for essential purposes.

Isolate/quarantine when indicated (see below) and wash your hands.

Quick Links to Resources

If you are looking for a test because you had close contact with a suspected/confirmed case, you need to quarantine: ph.lacounty.gov/covidquarantine (instructions changed 12/17/2020)

If you are looking for a test because you have symptoms, you need to isolate: ph.lacounty.gov/covidisolation

Free testing by appointment (walk-up and drive-up) https://covid19.lacounty.gov/testing/ - use a laptop or better for easier surfing

Testing links at Pasadena Public Health: https://www.cityofpasadena.net/public-health/covid-19-testing-info/

To check L.A.C. DPH vaccine eligibility: http://publichealth.lacounty.gov/acd/ncorona2019/vaccine/allocation/

To check Pasadena PHD vaccine eligibility: https://www.cityofpasadena.net/public-health/covid-19-vaccine/#vaccine-allocation-phases

Clinic Physician: Ann Walker, MD

COVID Update 1-20-2021 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

If you don’t read anything else, please read “Underselling the Vaccine” by David Leonhart here. 

COVID Vaccine and Education Sector Employees 

Employees of the education sector (faculty, staff, campus police and more) are part of Tier 1, Phase1b for COVID vaccination. Pasadena Public Health’s allocation page is saying this group is now eligible for vaccination though we don’t yet have details about how to sign up, the documentation you should bring, and whether persons in education sector jobs located within Pasadena are eligible even if they live outside Pasadena (this has been the case for healthcare workers). The L.A. County DPH allocation page is still saying early February for Tier 1, Phase 1b but they have green lighted persons 65 and older. PCC is applying to be a vaccine administration site but that is still probably 5+ weeks away if all goes smoothly. If you noticed that Long Beach and Riverside County Public Health have already started vaccinating education sector employees that’s because allocation and the pace with which new groups are added is a decision left to each Public Health Department. 

The Cupboard is Bare (For Now) 

The outgoing Health and Human Services Secretary, Alan Azar, announced last week that COVID vaccinations on reserve would be released. That looked like good news after the federal government and the CDC announcements encouraging an early expansion of COVID vaccination to persons 65+. Unfortunately, those reserve vaccines had already been shipped out in prior weeks. Persons due to get second shots are still expected to get them on time because second doses are prioritized over first doses. We can hope that the Pfizer and Moderna production continues without interruption; Pfizer agreed in July to deliver a million doses when approved; in December 2020 they agreed to deliver another 1 million by July 2021. Moderna has also agreed to deliver 1 million doses and a 2nd million doses by July 2021. 

Ready or Not, the More Contagious Variant is Here 

The current estimate is that the more contagious COVID strain from the U.K. will be the dominant source of infection in the U.S. by March. This variant is not more deadly and is not known to create more severe disease, but increased transmissibility means a further surge of new infections. Those new infections mean a further surge in hospitalizations which will inevitably result in a further surge of deaths.  

There is a concern that antigen tests for COVID could have a higher rate of false negative results with the new variant making this a good time to remind you that if you do antigen testing for COVID because you have symptoms and the result is negative, you need to recheck with a polymerase chain reaction (PCR) test. The specimen collection process won’t tip you off that you got an antigen test but most test results that are reported within 15-30 minutes of collection are antigen tests.  

To achieve a better outcome with this new variant, we need to take everything we have been doing and do it better. While any mask is better than no mask, masks with multiple tightly woven layers are clearly better than single layer. A tight, well fitting mask that covers your nose and mouth is far better than a loose mask. Even better than a great mask is avoiding being indoors with people outside your household. Don’t go into a grocery store if you have the option of curbside pickup or home delivery. Help make it safer for essential workers by staying home whenever possible.  

Why the “Next Generation” Vaccines Face a Rougher Road 

It is great to have several “first generation” COVID vaccines around the world, but the world needs much more vaccine than those companies will be able to produce quickly. The challenge is how to get people to participate in the phase 3 trials of the “next generation” vaccines when there are already approved vaccines, some with astounding efficacy. Is it even ethical to try to convince them to do so?  

You could try to incentivize participation by selecting two participants for active vaccine for every one placebo participant. Comparing new vaccines with one that is already authorized could eliminate the concern about getting a placebo. The downside is that good efficacy for either the new vaccine or the one to which it is being compared increases the time and number of participants needed to reach statistical significance.  

Another option is to use immune markers (antibodies, measures of cellular immunity, etc.) as correlates of protection. This is an established method for assessing efficacy of new influenza vaccines. The difficulty for COVID is that we don’t yet know which kind of immune response is a reliable indicator of vaccine-induced protection against the COVID virus. 

Every large vaccine trial is testing participants to try to identify meaningful correlates of protection. The more effective the vaccine is at preventing infection, the longer it takes to see “breakthrough” infection in vaccinated persons that may allow us to establish these correlates of protection that would allow us to evaluate the performance of other vaccines.  

COVID Vaccine FAQs of the Week 

Which is better, immunity from disease or mRNA vaccine? 

Go for the vaccine! There is still a lot we don’t know about COVID and about the vaccines, but we do know that COVID causes severe illness, lasting symptoms, or death even in people with no risk factors for severe disease or a poor outcome. The mRNA vaccines appear to nearly prevent severe illness in the very few vaccine recipients who are infected after vaccination. 

Will the COVID vaccine make me test positive on a COVID test? 

The mRNA COVID vaccines will NOT affect a PCR or Antigen test used to diagnose COVID. We would expect a COVID antibody test to be positive after a mRNA vaccine. 

Wednesday Funny 

 

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/05/Epidemiologist_.jpg 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household. 
  • Use social distancing, wear a mask, and choose outside or other increased ventilation when you leave your house for essential purposes. 
  • Isolate/quarantine when indicated (see below) and wash your hands. 

Quick Links to Resources 

  • This site is A LOT easier to use on a desktop/laptop compared to the mobile app 
  • Scroll all the way down to read about home testing with a mailed PCR kit  
  • Also see pop-up testing dates/sites designed for people without a car 

Clinic Physician: Ann Walker, MD 

COVID Update 1-13-21 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

Genomic Sequencing for Monitoring Mutations 

     Mutations are expected with viruses. They represent mistakes that occur in the process of duplicating genetic material. Most of the time these mutations appear to have no consequence other than creating the equivalent of a new fingerprint for that strain of the virus, allowing us to establish an ancestry of infection and trace the travel of the virus. Genomic sequencing told us that some of the early infections in the western US came from China and that many early infections in New York came from Italy. 

     Some mutations like the b.1.1.7 strain in Britain appear to result in increased transmissibility of the virus, making new infections more likely even with no increased risk in behavior. We can’t “see” these mutations unless we are looking for them and the US currently has no national approach with a clear mandate or resources to monitor mutations. The genomic sequencing being done in the US at scattered sites currently represents evaluating less than 0.25% of all new infections. Britain is the world leader, performing genomic sequencing on up to 10% of all new infections. It would cost us several hundred million dollars to duplicate this in the US, but that is a tiny fraction of the estimated $16 trillion in economic losses in the US due to COVID so far. 

     The consensus has been that the mutations we know about so far do not yet suggest that we need to redesign COVID vaccines, but this is a case of what we don’t know could hurt us.  

If You Could See the Future, Would It Change Your Behavior? 

     The Institute for Health Metrics and Evaluation (IHME) based at the University of Washington uses computer modeling to predict numbers of new COVID infections, hospitalizations and deaths. California was one of nine states they identified in October as likely to face a lockdown in December over mounting deaths.  

     IHME currently predicts that the surge in California’s cases per day will peak on January 27th at 135,800 new infections and that deaths per day will peak around February 9th at 652. Just to remind you where we are now, on 1/9/21 the 7 day average of new cases per day was 39,957 while the average of deaths per day was 452.  

     Can we still change these outcomes? The answer is most emphatically YES! Don’t wait for more cases and more deaths to decide that you will wear a mask more consistently, that you will reduce your mobility even further, that you will switch from shopping in the grocery store to curbside pickup or home delivery of online ordering and that you will do more to avoid close contact with anyone outside of your household. The actions of individuals will affect all of us.  

COVID Over the Long Term 

     The Lancet published a study of 1,733 COVID patients in Wuhan China sick enough to be hospitalized when they were ill 6 months ago. They found that 81% of the women and 73% of the men reported at least one unresolved symptom from their illness. The most common was ongoing exhaustion or muscle weakness. Other symptoms included diminished lung function, insomnia, depression and anxiety. 

    While it is the largest number of persons studied 6 months after COVID, it is not a comprehensive picture of the long term prognosis for the disease. They did not assess cognitive or neurologic function and did not note if depression or anxiety had been present prior to COVID illness. Several groups of persons were excluded from the study including nursing home residents, people readmitted to the hospital after their COVID admission, people too impaired to appear in person, and people with dementia or psychosis. 

     While it still appears correct to say that “most” people recover quickly and fully from COVID, some do not. There is some research, help and support for those with persistent symptoms. Those support groups include Survivor Corps, a large (>100,000 members) grass roots movement in America dedicated to action to end the pandemic. They facilitate registration for studies and trials for acute and long term COVID issues, and maintain a list of Post COVID Care Clinics in the US. Facebook has a “Long COVID” support group with 33,000+ members and Body Politic is a queer feminist wellness collective that has a COVID support group of 4,000+.  

COVID Vaccine FAQs of the Week 

     There are a lot of questions we plan to address but please reach out to us at medicalSHS@pasadena.edu if there is a question you are particularly anxious to see addressed. 

Can an mRNA vaccine change your DNA? 

No. The mRNA vaccines do not interact with your DNA in any way. mRNA from the vaccine enters cells and directs protein production in the cell. It is almost like a “Mission Impossible” tape recording that self-destructs after it has been read by a ribosome to produce the protein. The mRNA does not enter the nucleus of the cell and as a result cannot interact with your DNA. 

Do I need to keep wearing a mask and distancing when I have finished vaccination? 

Yes. While we know that vaccination reduces the chance of getting sick with COVID and for those who do get sick, reduces the chance of severe illness, there’s still a lot we don’t know including: 

  • Even if a vaccinated person doesn’t develop symptoms, can they become infected with COVID and transmit it to others? 
  • How long does vaccine protection against COVID illness last? 

We also know that about 5% of the time the vaccine fails to prevent illness with COVID. 

Wednesday Funny 

 

Adapted from gemma correll on Instagram  

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household 
  • Use social distancing, wear a mask, and choose outside or other increased ventilation when you leave your house for essential purposes 
  • Isolate/quarantine when indicated (see below) and wash your hands.  

Quick Links to Resources 

  • This site is A LOT easier to use on a desktop/laptop compared to the mobile app 
  • Scroll all the way down to read about home testing with a mailed PCR kit  
  • Also see pop-up testing dates/sites designed for people without a car 

Clinic Physician: Ann Walker, MD 

COVID Update 1-7-2021  

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students.  

Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only).  

We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p. 

How Good is That Cloth Face Mask? 

     When COVID infections first started in early 2020, hospitals were soon scrambling to find enough N95 and surgical masks to protect their frontline workers. It took until April 2020 before there was increasing agreement that asking the general public to wear a cloth face mask was beneficial for the wearer as well as those nearby with respect to reducing transmission of COVID outside of healthcare settings. 

     Since then there has been an explosion in the numbers of masks made for public sale. While the CDC advises that tightly-woven multilayered masks offer superior protection to a single layer of fabric or a loose knit mask, there has not been a standard for comparing one cloth face mask to another. That may change in the coming weeks. 

     The National Institute of Safety and Health (NIOSH), a division of the CDC is working with ASTM International, a standard-setting organization, to develop minimum filter efficiency standards along with labeling to identify masks that meet those minimums. They are proposing one high (50%) and one low (20%) filtration requirement. These numbers are more protective than they sound. The filtration efficiency percentages indicates blocking particles measuring 0.3 microns in diameter, generally the hardest size to block. A 20% filtration efficiency for 0.3 microns translates into a 50% efficiency for smaller particles and an 80% efficiency at blocking particles ≥4 microns. With respiratory droplets usually ≥10 microns and aerosols typically 1 to 10 microns, a mask meeting the “low” filtration requirement is still very effective, especially when paired with distancing and good ventilation. We can complain about how long it has taken to establish guidelines for the performance of cloth face masks, but its clear we can still use any extra help we can get while trying to end this pandemic. Furthermore, having this in place for potential future epidemics could be very helpful.  

Estimates of Viral Load 

     The gold standard for diagnosing COVID is a polymerase chain reaction (PCR) test that detects the virus. PCR tests perform multiple “cycles” to amplify the virus that causes COVID. If the virus is present in the sample, each cycle will double the quantity of the virus. A specimen is interpreted as positive if the quantity of the virus is high enough to be detected by the machine, and is negative if virus is still not detectable after 35 to 40 cycles. 

     Up to now results have always been reported as positive or negative, but as of December the FDA is allowing labs to also report the “cycle threshold”, the number of PCR cycles associated with an individual positive result. The higher the concentration of viral particles in the original specimen, the fewer cycles needed for a PCR test to be read as positive.  

     Using cycle threshold to estimate viral load has its limitations. Most COVID testing relies on swabbing the nose or throat which is prone to variations in technique of the persons collecting the specimen. We also know that viral load in COVID infections starts dropping quickly as the immune response surges. Despite these considerations multiple studies have shown that lower cycle thresholds are consistently linked to higher mortality even when controlling for the duration of symptoms before testing. Knowing the cycle threshold for a positive COVID test may help identify patients at greatest risk of death thus warranting closer monitoring and support as compared to those with higher cycle thresholds, which may allow a more beneficial use of limited medical resources.  

COVID Vaccine Hesitancy Up Close 

     Now that COVID vaccine is available the challenge is to get it into people. We know that in November 2020 as many as 20+% of people said that they did not intend to get a vaccine and, more importantly, were “pretty certain” further information would not change their mind.  

     It may be saddening but it shouldn’t be surprising that healthcare personnel are not immune to vaccine hesitancy. While a majority of frontline healthcare personnel are choosing to be vaccinated, a substantial minority have declined for now. The reasons to choose to delay are as varied as the persons making the decision. Pregnant persons must weigh the risks of COVID for themselves and their child against the very small amount data regarding vaccination and pregnancy, even though that small amount of data currently shows the vaccine to be safe and effective in pregnancy. Some may wonder if immunity from prior documented COVID infection may be sufficient for now. Some might wager that if they managed to avoid COVID while working on the frontlines for the past 10 months, perhaps their luck will continue. Some will decline because they have been swayed by disinformation or conspiracy theories.  While each person must make their own decision, the choices made by individuals will have a profound impact on this pandemic, for better or worse.  

COVID Vaccine FAQs of the Week 

     When it is your turn for the vaccine we are hoping you will say yes. While we are waiting, let’s start reviewing some of the frequently asked questions: 

Can the vaccine give me COVID? 

     No. None of the COVID vaccines in use or in development for use in the US contain live virus so they cannot give you COVID. 

     Remember that all vaccines take time to build immunity and even the best vaccines are not 100% effective, so it is possible to get vaccinated and still be able to get sick with COVID, although the infection is usually milder.  

Can getting the vaccine make me feel sick? (scroll down to reactogenicity under Patient Counseling) 

     About 80-90% of people who get the Pfizer or Moderna mRNA vaccines will notice local symptoms of pain, swelling or redness at the injection site; 55-83% will have systemic symptoms which can include fever, chills, headache, fatigue, muscle or joint pain.  Most systemic symptoms are mild to moderate in severity, usually start within 3 days of vaccination, and resolve spontaneously 1-3 days after onset.   

Thursday Funny 

 
Adapted from Facebook and Pinterest 

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household 
  • Use social distancing, wear a mask, and choose outside or other increased ventilation when you leave your house for essential purposes 
  • Isolate/quarantine when indicated (see below) and wash your hands.  

Quick Links to Resources 

  • This site is A LOT easier to use on a desktop/laptop compared to the mobile app 
  • Scroll all the way down to read about home testing with a mailed kit – discusses eligibility and detailed steps to complete the process 
  • Also see pop-up testing dates/sites designed for people without a car 

Clinic Physician: Ann Walker, MD 

COVID Update 12-16-2020 

Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. 
Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). 
We will respond to your inquiry during our business hours, Monday – Thursday 8:30a-4:30p, Friday 8:30a-12:30p.  

When You Get a Vaccine, Consider Getting V-safe Too 

The clinical trials supporting the emergency use authorizations for the emerging COVID vaccines involved thousands of participants, and have found the usual local (redness, swelling, pain) and systemic (fever, chills, fatigue, headache, muscle, and joint pain) side effects which are usually seen within three days of vaccination and resolve spontaneously over 1-2 days. Experience tells us that when any vaccine is given to millions of people you can expect to discover other side effects that were simply too rare to be picked up in the clinical trials. 

There are existing tools for capturing adverse events with vaccines, although they are largely “passive,” dependent on patients or providers initiating reports. The CDC and FDA have developed V-safe, a smartphone-based active monitoring program for COVID vaccine side effects. It will use text messaging and web surveys to check in with vaccine recipients who enroll. 

These check-ins will occur daily for the first week after vaccination, then weekly for 6 weeks and finally at 3, 6 and 12 months after vaccination. The check-in process resets if the vaccine you receive requires a second dose. If you report a clinically important health impact, a CDC representative will contact you by phone and take a report if appropriate. To learn more about V-safe go to www.cdc.gov/vsafe. When you get a COVID vaccine, you should be given documentation of the vaccine you receive and an information sheet with the link to the V-safe website where you can enroll.  V-safe will also remind you when you are due for a second dose for all 2 dose vaccines. 

Getting a Vaccine Won’t Mean Ditch Your Mask, At Least Not Yet 

We know that the Pfizer and Moderna vaccines are highly effective at preventing COVID illness, but that’s not the same thing as preventing infection. If vaccinated people can still be infected with COVID, even with no symptoms, they can also be infectious to other people if the load of virus they carry is high enough. 

We may have a better idea of the frequency of infection after vaccination when Pfizer tests some, and Moderna tests all, clinical trial participants for evidence of COVID infection by looking for antibodies to the N protein of the COVID virus. Because the vaccines generate antibodies to the spike protein and not the N protein, anybody with N protein antibodies has been infected by COVID. The Johnson & Johnson vaccine trial intends to analyze antibody content not only in blood but also in saliva; if antibody levels in saliva are as high as those in blood, it may bode well for fending off COVID infection in mucosal tissues including the nose. Even a reduction in the amount of virus replicating in the nose would reduce the risk of transmission to other people.  

Indoor Transmission Happening Faster and Farther Away Than Previously Thought 

How was a high school senior in Jeonju, South Korea with limited public activities diagnosed with COVID on June 17th when there had been no COVID cases in her city for 2 months and no cases in her province for 1 month? Using cellphone location information and credit card data, the South Korean Epidemic Surveillance System determined that for 5 minutes on June 12th she was 20 feet away in a diner from a traveler from another province who was subsequently diagnosed as a case. CCTV footage documented that the two never spoke or touched any surfaces in common. That same footage demonstrated that the overhead air conditioning unit was on at the time based on swaying of a light fixture. 

Genome sequencing of the COVID virus recovered in the traveler, the high school senior, and a third person infected in the diner confirmed they all had the same strain of COVID. The high school senior and the third diner who was infected had been sitting directly in the flow of air from the air conditioner, downwind from the infected traveler. Other diners who had their back to the airflow were not infected. 

Don’t Forget CA Notify 

CA Notify provides anonymous notification to you if you may have been in contact with a person who has a positive COVID test. If you enable CA Notify on your phone and a person with a newly diagnosed COVID case enters the verification code from their positive test results, then you will receive anonymous notification of possible exposure based on the random codes exchanged between enabled devices. The system is a voluntary and completely anonymous way to help alert people to possible exposure. Go to https://canotify.ca.gov/ for more information.  

Wednesday Funny – Little Bear’s post vaccine wish; not sure how far post-vaccine that will need to be! 


Adapted from: https://twitter.com/acechhh/status/1336708767271051265  

Basic Preventive Measures 

Help more people live to see and hug their family and friends outside their household again: 

  • Continue to limit your close contact to people within your household 
  • Use social distancing, wear a mask, and choose outside or other increased ventilation when you leave your house for essential purposes 
  • Isolate/quarantine when indicated (see below) and wash your hands.  

Still not too late to get a flu shot! 

Quick Links to Resources 

  • Scroll all the way down to read about home testing with a mailed kit – discusses eligibility and detailed steps to complete the process 
  • Also see pop-up testing dates/sites designed for people without a car 

Clinic Physician: Ann Walker, MD 

COVID Update 12-9-2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Will Enough People Get the Vaccine to End the Pandemic?

We will need enough people getting vaccine to achieve a national immunity rate of at least 60-70% to help end the pandemic. Knowing that only a portion of the vaccines available will have an efficacy as high as the Pfizer and Moderna vaccines we will likely need as much as 80% of the population to agree to vaccinate.

The November 18th-29th poll of 12,000+ adults by Pew Research in America indicates that 60% say they would definitely get a vaccine if one were available today, up from 51% in September.  On the downside, 21% of those surveyed do not intend to get a vaccine and are “pretty certain” that more information won’t change their mind.

While the uptick in intent to get a vaccine is broad based there remain sizeable differences among key demographic groups.

Intent to get vaccine by race:

  • Black 42%
  • White 61%
  • Hispanic 63%
  • Asian 83%

Intent to get vaccine by age:

  • 18-29 years old 55%
  • 65+ years old 75%

Intent to get vaccine by income adjusted for cost of living and family size:

  • Lower income 55%
  • Higher income 71%

While the public intent to get a vaccine and confidence in the vaccine development are up, only 37% of those surveyed would be comfortable being among the first to get a vaccine.

The overall toll of the pandemic is starkly illustrated by the 54% of respondents who say they know someone who was hospitalized or died of COVID; that goes up to 71% for Blacks in the survey.

The Current State of Vaccine Development

You know that Pfizer and Moderna are in the emergency use approval process with the U.S. FDA. The preliminary results of their phase 3 large-scale efficacy trials of messenger RNA vaccines are reporting an efficacy of 95%. Just as important, none of the vaccine recipients who have been infected had serious disease.

There are 12 other vaccines in Phase 3 trials around the world. These include:

  • 4 viral vector vaccines – CanSinoBiologics in China, Gamaleya Research Institute in Russia (“Sputnik V”), Johnson & Johnson in the US and Astra Zeneca in the UK
  • 3 protein-based vaccines – Novavax in the US, Medicago in Canada and the Chinese Academy of Medical Science
  • 4 “killed” virus vaccines – SinoVac in China, Baharat Biotech in India and two from SinoPharm in China
  • 1 “repurposed” vaccine – Murdoch Childrens Research Institute in Austrailia studying the Bacillus Calmette-Guerin (tuberculosis) vaccine

Seven vaccines have been given early or limited use approval outside the U.S. including:

  • CanSinoBiologics vaccine in June 2020 in China before phase 3 trials
  • Two SinoPharm vaccines in September 2020 in China and the United Arab Emirates during phase 3 trials
  • SinoVac vaccine in July 2020 before phase 3 trials began
  • Gamaleya “Sputnik V” vaccine in August 2020 before phase 3 trials
  • Vector Institute in Russia EpiVacCorona vaccine in October 2020, phase 3 trials not yet started
  • Pfizer vaccine given emergency use approval in the U.K. as of 12/2/2020, phase 3 ongoing

There are also 17 other vaccines in phase 2 expanded safety trials and 41 more vaccines in phase 1 testing safety and dosage trials.

Statewide Launch of CA NOTIFY

Newsome announced the 12/10/2020 launch of CA Notify, a smart phone tool to slow the spread of COVID. If you choose to enable CA Notify on your iPhone or download the CA Notify app from Google Play Store for an Android device your phone will exchange random codes with other enrolled smart phones without revealing identities or locations. If a CA Notify user has a positive COVID test they receive a verification code from CDPH that they can choose to plug into the app. Any other CA Notify users who have been within 6 feet for 15 minutes or more of the device associated with the verification code will get an anonymous notification of possible exposure. It is a long shot – smartphone users need to opt in, they need to keep their phone on and with them and they need to choose to download the verification code if they get a positive test result. It seemed to be helpful on the UC campuses that piloted the app. You can get more information at https://canotify.ca.gov/.

Wednesday Funny

Why, of course, it’s Putin on the Ritz! 

Adapted from: https://twitter.com/SpinoniSharp/status/1024737615256412160

Basic Preventive Measures

You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twindemic” by getting a flu shot with choices including:

  • Almost every pharmacy, often free if you have insurance; the lowest cash price we found was under $20 at Costco (and you don’t have to be a member to use the pharmacy)

Quick Links to Resources

Clinic Physician: Ann Walker, MD

COVID Update 12-2-2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Safer at Home for LA County and State Curfew

      On November 21st, the State of California required that all counties with widespread transmission of COVID stop all non-essential work and activities between 10:00 p.m. and 5:00 a.m. As of Monday November 30th, L.A. County’s targeted Temporary Safer at Home Health Officer Order went into effect with residents advised to stay home as much as possible and always wear a mask when outside of their households and around others. Follow the link to see how this order affects occupancies at businesses that remain open. These changes to the Health Officer Order will be in effect through 12/20/2020 with further decisions about loosening/tightening based on COVID transmission and hospitalization rates.

Another Way to Look at Risk for Infection

      The Department of Health Services Modeling Team started providing a prevalence figure in mid-June to help people understand the far reach of the COVID virus. For every person sick enough to be hospitalized with COVID there are about 40 others who are infected but not hospitalized. The modeling adjusts for the fact that each of these un-hospitalized sick persons is most likely to infect others over a 2 to 5 day span of their illness.

      Two months ago, this worked out to 1 out of 800 Angelenos being currently infectious on any given day. On 11/25/2020, the prevalence was 1 out of 145. Dr. Mark Ghaly who leads the California Health and Human Services Agency sums it up saying, “You’re more likely to get infected with COVID just because it’s more available and more around our communities even if you behave exactly as you did a month ago”.

      The only way to bend the curve back down is to behave differently. We need to mask more, distance more and, for those of us privileged enough to have the option to do so, stay home more.

Astra Zeneca’s Preliminary Vaccine Results: Useful Mistake or a Serious Issue?

      There were more questions raised than answered when Astra Zeneca released preliminary efficacy data for their COVID vaccine built on an adenovirus last week. The Astra Zeneca vaccine is being studied as two doses given a month apart but we learned early last week that some 2,800 participants mistakenly received a first dose that was only half strength.

      The unexpected result is that for participants with the half strength first dose the vaccine efficacy appears to be ~90%. The efficacy for participants with the intended two full strength doses was 62%. Why would less vaccine produce a better result? Dr. Anthony Fauci offers the observation that “a smaller initial dose may ‘tickle’ the immune system enough to generate T cells but not trigger development of antibodies that might work to suppress the response to the booster shot”.

      The “glass half full” opportunity in this dosing mistake is the chance to study the mixed dosing further which Astra Zeneca plans to do. Also, on the plus side, this vaccine is easier to mass produce and store and may cost as little as $3 to $4 per dose.

      On the “glass half empty” side, this announcement pooled results from two differently designed phase 3 trials in Britain and Brazil, a break from standard practice in reporting the results of drug and vaccine trials. It also appears that the participants who received the half strength first dose were all 55 years old or younger; only further trials can tell us whether the same high efficacy results will be seen in older patients. Equally troubling, the statistical calculations done before the phase 3 trials began to identify the meaningful points in the trial to evaluate the results assume that all study participants were handled by the same protocol which is not the case. And don’t even get me started on the private conference calls with industry analysts reported to provide further details not shared with the public; it may be true that such disclosures to analysts are not uncommon in the industry but in a setting that has such an overwhelming need for transparency, they are disturbing.

New CDC Quarantine Instructions?

      The transcript of the press release is not on the CDC web site yet but news outlets are reporting that the CDC is proposing a reduction in quarantine to a 7-day period if followed by a negative COVID test (or a 10-day quarantine with no test) for exposed persons who do not develop symptoms during their quarantine. While the 14-day quarantine period is still supported as the safer option, these shorter periods are felt to result in only a “small residual risk that the person leaving quarantine” could be infectious to others.

      These proposals are based on the median incubation time of 5 days following exposure and a recognition of the difficulty of implementing 14-day quarantines. On a local level, the medical advice cannot change unless L.A. County Public Health makes changes in their Health Officer Orders for Quarantine.

Wednesday Funny

Press release in the aftermath of Biden’s right foot fracture after slipping while playing with his dog Major:

      Adapted from: https://twitter.com/firstdogsusa/status/1333733927366897664/photo/1 

      Adapted from: https://twitter.com/evilpez4/status/1333187424730697731/photo/1

Basic Preventive Measures

You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twindemic” by getting a flu shot with choices including:

  • Almost every pharmacy, often free if you have insurance; the lowest cash price we found was under $20 at Costco (and you don’t have to be a member to use the pharmacy)

Quick Links to Resources

Clinic Physician: Ann Walker, MD

COVID Update 11/25/20

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Hot Off the LA County Public Health Press

     As of Sunday 11/22, the 5-day average of new cases per day for LA County was 4,097, triggering a minimum 3 week restriction of restaurants, breweries, wineries and bars to take-out, drive-through and delivery services, taking effect Wednesday 11/25at 10pm.  By Tuesday 11/24 LA County Public Health was announcing that the 5-day average of new cases per day was over 4,500, enough to trigger a Targeted Safer at Home Order which will be issued for at least 3 weeks. While the details of those restrictions are still emerging DON’T KID YOURSELF ABOUT WHAT THIS MEANS. Help in the form of vaccines is only months away but that won’t help the people who die or develop chronic complications of COVID before the vaccines arrive.  If you are celebrating Thanksgiving, take your cue from Dr. Ferrer:

“The safest way to celebrate Thanksgiving is to celebrate at home with the people you live with….Given the huge surge in cases across the country this past week, we strongly recommend that you only celebrate the holiday with people from your household and that you not gather at all with people from outside your household to eat this meal — even if you’re outdoors.”

Resources for a Fully Remote Thanksgiving

     If you have made the painful decision to not gather with family and friends outside of your household for Thanksgiving, you may want some of the software and hardware tips for connecting remotely. If you are not reading this until after turkey day the painful truth is these same approaches will be useful for Christmas, Kwanza, Hanukah, Eid al-Fitr, Winter Solstice and New Year’s Eve.

     Zoom will lift its 40-minute limit on group calls for free accounts globally starting just after midnight (Eastern time) Thursday 11/26 through 6am Friday 11/27. Don’t like Zoom? Consider Google Duo, the Group feature of FaceTime or the Rooms feature of Facebook Messenger as alternatives.

     Consider creating a slide show of digitized family photos or aim your web camera at a photo album. With permission you can hit record as the family stories start to flow in response to the pictures from the past. After the meal may be a good time to use the Houseparty platform to host games of Quick Draw, Chips and Guac, Heads up, Trivia and more. The Trickster Cards app lets you play Heats, Pinochle, Bridge and other familiar card games. There are also “watch party” apps and browser extensions to sync up video and add a chat function for everyone viewing together.

     Take what you learn this holiday to make the next ones even more fulfilling and look forward to when we won’t be risking our health to be together.

Perhaps it Starts with Remembering that We are All Humans

     COVID is surging nearly everywhere but is especially cruel inside America’s prisons and jails where overcrowding, antiquated and poorly ventilated structures, uneven testing, inadequate medical resources along with a constant churn of inmates, visitors and staff combine to amplify transmission and illness. The reported case rate among inmates is more than 4 times higher than the general population and their death rate is more than twice as high while the case rate among staff is more than 3 times the general population.

     In the spring there was a push to reduce risk in correctional facilities by reducing overcrowding through early release and decarceration measures. There was an 11% decrease in the spring, mostly due to declines in arrests and closure of state and local courts. The number of incarcerated persons began growing again over the summer and in many places is now higher than before the pandemic. What we need is a greater commitment to noncustodial penalties for minor infractions and a reduction of pretrial detention through reducing or eliminating bail but not by replacing bail with an unaccountable assessment of risk that is prone to double down on existing inequities and systemic racism.

     Our constitution instructs that inmates should be protected from “cruel and unusual punishment” but our failure to bring the virus under control in our prisons and jails is a moral and public health catastrophe.

Wednesday Funny

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/07/Screen-Shot-2020-07-19-at-9.44.24-AM.png

Adapted from https://voicesofmontereybay.org/wp-content/uploads/2020/08/if-2020-was-tp.png

Basic Preventive Measures

      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twindemic” by getting a flu shot with choices including:

  • Almost every pharmacy, often free if you have insurance; the lowest cash price we found was under $20 at Costco (and you don’t have to be a member to use the pharmacy)
  • A. County Public Health Clinics this link is contact information from January 2020, call and ask about flu shots/cost
  • Other L.A. free/low-cost vaccination clinics this link is contact information from 2018, primarily for children ≤18 but some can vaccinate adults also, call and ask about flu shots

Quick Links to Resources

Clinic Physician: Ann Walker, MD

COVID Update 11/18/2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Possibly the Best News Besides the Performance of the Pfizer and Moderna Vaccines

      There are an increasing number of studies suggesting that immunity to COVID after infection may be long lasting for most people. While antibody levels in the blood decrease over time (a normal finding for most infectious diseases) the B and T cell immunity appears to persist. The expectation now is that nearly all persons recovered from COVID will have sufficient immune memory to prevent them from having reinfection bad enough to hospitalize them.

      This is compatible with the finding that the survivors of SARS, the first novel coronavirus in 2002-2003, still have enough immunity to fend off reinfection with the SARS even now, almost 20 years later. The observation that the SARS-CoV-2 virus that causes COVID is typically slow to do harm also gives the immune system time to kick into gear.

      This is all very good news for anybody who has already had COVID and supports the hope that immunity due to vaccination may also be durable.

Thursday’s PCR Test is Not a Green Light to Saturday’s Party

      Everybody is looking for more freedom and many are trying to be safer in their choices. It is a mistake to think that a negative PCR test one day becomes a passport to carefree socialization in the following days. You can get a negative PCR result when you are already infected with COVID if that test is done before the virus multiplies enough to be detected. You can also acquire infection after your test is collected and have a short incubation period with the result that you have enough virus to infect others within 1-3 days.

     Adults ages 18-29 are currently the largest proportion of newly diagnosed COVID in L.A. County followed by adults ages 30-45. To walk our case rates back from the edge of disaster while we wait for vaccines, we must recommit to the basic preventive measures of masking, physical distancing, avoiding gathering with persons outside of our household, staying home when sick and hand washing. As Dr. Ferrer of L.A. County Public Health puts it, “this isn’t like we don’t know what to do, this is about getting back to what works”.

A Promising New Test of Prior COVID Infection and Possibly a Measure of Vaccine Durability

      We know that immunity to COVID is not only a function of antibodies but also the T and B cells of the immune system. It is not ready for commercial release but Adaptive Technologies is working on streamlining a test for measuring T cell receptors that recognize parts of the virus that causes COVID. Looking for these COVID specific T cell receptors may allow us to more accurately identify people who have had prior COVID infection and may also provide a way for vaccine manufacturers to track the durability of T cell response to their vaccines.

Extra Steps to Making Thanksgiving Safer

      In terms of COVID risk, it seems that the timing of Thanksgiving couldn’t be worse. We know that small gatherings are fueling much of the current steep rise in cases.

      Ventilation in your home may be the single largest factor to address to reduce risk. Most houses by design are poorly ventilated – it helps them achieve energy efficiency for summer cooling and winter heating. The air in typical homes changes every one to two hours but the World Health Organization recommends at least 6 air changes per hour to reduce viral spread.

      Be grateful you live in Southern California and throw open multiple windows. That alone can increase the ventilation to as much as 3 air changes per hour. Adding portable air cleaners and turning on stove and bathroom exhaust fans can also help. If possible, move some or all of the meal outside. Run your HVAC system to pull air through that high MERV filter to trap viral aerosols. Think about adding a humidifier to push the indoor humidity up to 40-60% where your nose and upper airways may better resist the virus and viral aerosols may be cleared more quickly.

      The highest value intervention for Thanksgiving is to reduce the number of persons present, and if possible, to include only those persons in your household so that more of us can live to celebrate Thanksgiving after the pandemic. When not eating, masks should be worn; avoid sharing serving utensils and keep your gathering short.

Wednesday Funny

      Adapted from: https://www.pinterest.com/janismeixsell/my-inner-t-rex/

Wednesday Not Funny

      Adapted from: https://twitter.com/Vaccinologist/status/1327708210749448195

Basic Preventive Measures

      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twindemic” by getting a flu shot with choices including:

  • Almost every pharmacy, often free if you have insurance; the lowest cash price we found was under $20 at Costco (and you don’t have to be a member to use the pharmacy)
  • A. County Public Health Clinics this link is contact information from January 2020, call and ask about flu shots/cost
  • Other L.A. free/low-cost vaccination clinics this link is contact information from 2018, primarily for children ≤18 but some can vaccinate adults also, call and ask about flu shots

Quick Links to Resources

Clinic Physician: Ann Walker, MD

COVID Update 11/11/2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Flu: Protecting Yourself and Others - Join Us!

      Do you have questions about the flu? Have you heard any myths surrounding the flu shot? Please join Student Health Services live on YouTube on Tuesday, November 17th at 12 noon to get answers! All are welcome to participate.      More information can be found through Student Health’s social media (Facebook, Instagram, Twitter, and YouTube): @PCCHealthWell

Thinking Ahead About Thanksgiving

      The U.S. is headed up the steep side of a third wave of COVID cases. For the week ending 11/7, the U.S. is now averaging 102,000 new COVID cases every day. If you have decided to resist giving in to pandemic fatigue, now is the time to think about how you want to approach the winter months and holidays to reduce the risk of infection for yourself, your household, and the community around you.

      Our northern neighbor Canada celebrated Thanksgiving on October 12th. Canada’s cases per 100,000 persons per day had been at or under 1 through July and August and had risen to 3 cases per 100,000 persons per day by the end of September (2 weeks before their Thanksgiving). Currently, at 3 weeks after their Thanksgiving, the rate has nearly tripled again to 8.6 cases per 100,000 persons per day based on World Health Organization data.

      The U.S. is now less than 3 weeks away from its Thanksgiving. The U.S. had 24 cases per 100,000 persons per day as of the week ending 11/7 and the number for L.A. County is 17 cases per 100,000 persons per day. If our experience is similar to our northern neighbor, the U.S. will be looking at 238,000 new COVID cases every day in the week before Christmas and Los Angeles’ share of that will be 5,200 cases per day. If you don’t like the looks of where we are headed, now is the time to double down on masking, distancing, and redirecting any large family gathering you may have hoped to have, into a distanced event that protects you and the people you care about the most.

A Nasal Spray to Prevent COVID While We Wait for a Vaccine?

      There is a preprint article about a nasal spray that prevents COVID in ferrets. Ferrets are used by scientists to study flu, SARS and other respiratory diseases because ferrets can catch viruses through the nose just like humans. The study at Columbia developed a spray containing a lipopeptide – a cholesterol particle attached to a chain of amino acids. In this case, the chain of amino acids matches a stretch of amino acids in the spike protein of the COVID virus. This is a stretch of amino acids that we already know mutates only rarely.

      When the lipopeptide latches onto its matching portion of the spike protein, the virus is no longer able to use the spike protein to fuse to the wall of the cell. Without fusion, the virus cannot inject its RNA into the cell, a necessary step in initiating infection in the cell.

      Ferrets treated with the lipopeptide spray did not become infected with COVID when caged with an infected ferret but the ferrets in the same cage who got the placebo spray did become infected. We still need toxicology and human studies before we will know if this spray could be used to protect people but, the guess is that it can be inexpensively produced as a freeze dried powder which would not need refrigeration. When dispensed, it could be remixed to produce a nasal spray. Low cost and ease of handling/administration would make it a much more feasible option for the world than the expensive monoclonal antibody preventives.

More on Animals and COVID

      We have already discussed that dogs and cats get infected with COVID but so far have not been found to transmit the virus back to humans. Any species that can be infected with COVID and transmit it back to humans could become a reservoir for the virus. If there is a reservoir for the virus, it would provide an opportunity for the virus to mutate with the chance of developing more transmissible or more lethal strains of COVID.

      The mink industry in Denmark is being wiped out as we speak and northern Denmark is on lockdown because transmission from minks to humans has been proven and we also know that the virus has mutated within the mink population (as it does in humans) with one of the variants being less responsive to antibodies.

When the Immune System Goes Astray

      There is more evidence that some patients with COVID end up developing autoantibodies, antibodies that target proteins or genetic material from the patient’s body instead of the virus. This may happen, in part, due to a pre-existing defect in the immunity cells known as “B cells” but an immunologist at the University of Washington in Seattle says that any time you have a combination of inflammation and cell death, there is the potential for autoantibodies and autoimmune disease to emerge.

      The good news is that we already have some tools for modifying autoimmune processes. Only time will tell whether the autoantibodies in COVID survivors represent a temporary or permanent change in the patient’s immune system.

Why Every Day Feels Like Blursday

      Do you find yourself having trouble remembering the day of the week? Does it feel like three years since the lockdown in March? Monotony, chronic stress and isolation are destroying our sense of time.

      In the absence of the familiar holiday celebrations, typical workweek commuting, vacations, and gatherings, the brain has a harder time processing and cataloguing memories. Monotony has the ability to warp time and tangle memories. On top of monotony there is a crushing collection of worries: a killer virus, political chaos, increasing difficulty meeting basic needs for shelter and food, ongoing systemic racism and quickening environmental change to name a few. It leaves many stuck in a lousy present with little sense of (or hope for) the future.

      Isolation itself can distort the shape of days, weeks, and months. When we are isolated, we lack the psychological anchors in time and space that other people provide for us.

      How to respond? With an unknown number of months remaining in which we still need to hide from the virus, we need to focus on creating our own safe seasonal celebrations, our own stress reducing tools, and safe milestone celebrations that can push back against the monotony, crises and isolation of our current life as the calendar pages flip.

Wednesday Funny

Adapted from https://thehoneycombers.com/bali/funny-coronavirus-memes/

Basic Preventive Measures

      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands.       Help avoid a “twindemic” by getting a flu shot. The free flu clinics appear to be done but if you have insurance, it should be free. If you don’t have insurance, the public health and low-cost clinics below may be an option:

 

Quick Links to Resources

Clinic Physician: Ann Walker, MD

11/4/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Leading Story this Week – Get Your Flu Shot! Here Are Some FREE Sites:

More on the Flu and COVID “Twindemic”
      The last thing our strained hospitals need this winter is people sick enough to need care for an illness that could have been prevented or made significantly milder by timely vaccination. If you are thinking maybe you can skip the flu shot because you know that the 2020 flu season in the Southern Hemisphere (their winter is June-August) was so mild, think again. The Southern Hemisphere did have phenomenally low rates of influenza infection for this most recent season but there are several variables to consider. Looking at Australia, they had stronger than usual flu vaccination rates. They also had social distancing in place for COVID prevention (works against both viruses) and have what many describe as onerous restrictions on entering the country. Influenza typically spreads around the globe and within countries based on travel patterns.
      By contrast, only 45% of American adults got a flu shot in 2018-19. Currently accelerating COVID case numbers are evidence of our currently less than sufficient social distancing (locally and nationally) and compared to Australia, we have few travel restrictions internationally and internally.
      If you are still teetering on whether or not to get a flu shot, please contact us through medicalSHS@pasadena.edu and give us an opportunity to try to answer your questions.

Lower Death Rates for COVID Patients – It May Not Last
      It has been a grim year with COVID. Who can forget the refrigerated trucks parked on the streets of NYC as overflow morgues? It is truly good news that the rate of death from COVID has fallen from a high of 25-30% of hospitalized patients in March to 3-7% in the summer even though those lower numbers are still much higher than we see for flu or other respiratory diseases.
      Before we let the good numbers make us complacent, there is NO evidence that the virus is less deadly than it once was. Some of the drop is due to the shift in hospitalizations to younger adults; by the end of August the average patient age was under 40. Some of it is due to heightened community awareness and patients seeking care before they become desperately ill.
      A likely significant factor is we have learned a lot about managing the disease. We know better when to use steroids (initially considered unwise based on early reports from Wuhan, China and Italy), prone positioning and anticoagulants (to avoid COVID induced clotting problems).
      Undoubtedly, backing off on the crushing load of patients during those early months in New York has also helped reduce mortality rates. We have an easier time keeping up with staffing, stamina and equipment when hospitals are not packed to the gills.
      We will lose that last advantage if our case rates continue to increase. The number of hospitalized patients across the country has increased by 40% over the last month. Hospital administrators in Idaho, Utah and Kansas City, Missouri have warned they are already close to capacity. In the words of Tom Inglesby, director of the Center for Health Security at Johns Hopkins University, “if hospitals that aren’t prepared for large numbers of people have to deal with a large influx of COVID patients, or small hospitals get pulled into it, we should expect that mortality could change”. 

Wednesday Visual – Tessa shows us how to wear a mask!

Adapted from  https://www.yourcentralvalley.com/news/local-news/how-to-wear-a-face-mask-by-tessa-the-fresno-fire-dog/ 

Basic Preventive Measures
      Besides getting a flu shot, these are STILL the tools at your disposal:

  • social distance
  • wear a mask
  • choose outside or increased ventilation
  • isolate/quarantine when indicated
  • wash your hands

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

 

10/28/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Surfaces + COVID = Wash Your Hands!
In the beginning of the pandemic, packages and mail were put into quarantine and packaged groceries were wiped down with disinfectants. We didn’t know how the COVID virus spread and lab studies were showing that it was still detectable for hours on cardboard and for days on plastic and steel. Those initial studies were not wrong but it appears they did not ask the right question. The fact that you can detect virus on a surface does not tell you whether it can create infection. In lab studies, virus samples are deposited on surfaces within synthetic substances or blood serums specially designed for stability studies. Those surfaces are then maintained in environments that do not necessarily reflect real world conditions. Those surfaces were then sampled over time to see if virus is still detectable. It is not surprising that the virus recovered was still capable of growth in a cell culture, a measure of infectivity. In contrast, more recent studies of samples gathered from highly contaminated surfaces (COVID hospital wards and COVID quarantine hotels) revealed abundant virus by diagnostic testing but no viable culture and reproduction of the virus that was collected.
      There are likely several factors responsible. Lab conditions can be far different from “normal life”. Saliva is normally part of the aerosols and respiratory droplets that can result in virus deposited on surfaces, but saliva also has enzymes designed to denature viruses (one of the challenges of saliva-based testing strategies).
      Low risk is not zero risk and prudence dictates that high touch surfaces merit disinfection. At the same time, it is important to avoid having attention to low risk exposures exhaust your ability to focus on things that matter more. 

The truly simple solution when it comes to COVID and surfaces boils down to frequent handwashing.

New Collaboration
      To address disinformation about COVID, the World Health Organization (WHO) has collaborated with Wikipedia. As one of the world’s 10 most consulted sites with ~175 languages, Wikipedia will have free use of published information, graphics and video from WHO. The staff of 6 people at WHO responsible for digital content management will have the assistance of the 200+ volunteer editors on WikiProject COVID-19 to monitor changes made to WHO information. In time, this collaboration will include live links which will update global case and death numbers on Wikipedia as they are posted by WHO. 

Two Vaccine Trials Restarted
      The FDA lifted the 6-week clinical hold on the U.S. arm of the Oxford/Astra Zeneca phase 3 viral vector vaccine trial. The unofficial account is the FDA did not directly tie the vaccine to 2 cases of transverse myelitis but did advise Astra Zeneca to alert study volunteers about symptoms like weakness and numbness that might be present with a mild case of transverse myelitis.
      Johnson and Johnson had paused its phase 3 viral vector vaccine trial for 11 days to evaluate a “serious medical event” in one trial participant before resuming on 10/23 after determining there was no evidence that the vaccine caused the event. This conclusion was reached without the evaluators knowing whether the participant received the vaccine or the placebo which helps remove bias from the process of evaluating the event.
      In typical vaccine development, none of this information would have been released until after the phase 3 trial was completed. Adverse events are not uncommon in large-scale vaccine trials. In some cases they are caused by the vaccine but usually they are coincidental, simply a matter of chance. 

A More Accurate Measure of Death Due to COVID
      You might think that death due to COVID is easy to count but it is not. Some of what we miss is because of the times and places that testing has not been available. Some are deaths that are not COVID infection but are deaths that would not have occurred without the societal, economic and healthcare changes that are a result of COVID. Consider inability to seek timely care because of fear of infection and loss of healthcare coverage due to COVID related job loss to name two causes.
      When you have historical data for comparison, you can determine if the overall death rate is higher than similar matched time spans, looking for “excess deaths”. The CDC looked at weekly deaths from January 26th to October 3rd in 2020 and compared those numbers to the corresponding weeks for 2015 through 2019. The estimated “excess deaths” for that period in 2020 is 300,000 with ~198,000 directly attributable to COVID and ~100,000 to other causes.
      One of the surprising findings is that the percentage increase in deaths was highest in the 25-44 year olds (26.5%) compared to the 65-74 year olds (24%) and the 45-64 year olds (15%). Not surprisingly, the percentage increase in deaths by racial groups showed many of the same inequities as seen with every other COVID statistic, 54% in Hispanics, 37% in Asians, 33% in Blacks, 29% in Alaskan/Native American and 12% in Whites.

Wednesday Funny

https://imgflip.com/i/4ff91x

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

  

 

10/21/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

App for Estimating COVID Risk of a Single Event
      Brown University Lifespan Center for Digital Health has released an app to estimate the risk of COVID infection for a single event based on variables including geographic location, number of people, setting (indoors vs outdoors), duration, mask compliance etc. In future versions they hope to be able to address the cumulative risk of multiple activities over a stretch of time. The risk scores range from very low (less than 1 in 10 million) to very high (five or more out of 100, roughly the infection risk of caring for a family member with COVID). You can read more about this app and its limitations. The app can be downloaded at https://www.mycovidrisk.app/.

Increased Fear to Combat Pandemic Fatigue?
      Are you looking for extra motivation to re-commit to the basic preventive measures and get your second wind for the marathon that remains to get to the other side of this pandemic? You may need to look no farther than the personal accounts of the growing numbers of post-COVID patients reporting “brain fog”.
      Brain fog (episodic memory loss, confusion, difficulty focusing, struggling for common words) varies widely and includes people who were only mildly physically ill with COVID and had no previous medical conditions. Leading theories are that it arises when the body’s immune response to the virus doesn’t shut down or when there is inflammation of blood vessels in the brain. The episodes may represent persistent immune activation after the initial infection subsides. The scariest part? It’s too early to know how much these symptoms will improve (much less resolve) and how long that improvement/resolution will take.

Another Look at Reinfection with COVID
      So far there have been four published cases of confirmed reinfection with COVID with another twenty cases in the scientific review process. The good news is that these numbers are so small compared to the 40+ million cases worldwide so far. Even better news – only three of those 24 had a more severe course with the second infection compared to their first.
      Between the scarcity of testing early on (at least in the U.S.) and the mild to asymptomatic nature of most second infections found so far, we know that we are not finding all cases of reinfection. On the upside, people with more severe symptoms on a second infection are more likely to present for care and if reinfection were common, we would have found thousands of cases.
      The take home message is to continue masking and distancing even if you have recovered from COVID. There are reasons to believe that vaccine-induced immunity should perform better than natural immunity. 

A Fundamentally Different Trial of Vaccines
      Imperial College of London is preparing to do a human challenge trial to compare the performance of a handful of COVID vaccines though the vaccines have yet to be picked. This approach involves purposefully exposing trial participants to the virus, all of whom have been previously vaccinated with one of the 3 to 4 vaccines being compared. Those participants are held in a medical isolation unit and evaluated for development of disease.

   Some of the upsides of this approach:

  • You select healthy 18-30 year olds whose overall risk of severe disease is lower
  • You can control the dose of virus to which participants are exposed
  • When you see signs of infection you can start remdesivir
  • You get information faster than waiting for “natural” infection

    Some of the downsides of this approach:

  • Studies in young, healthy patients doesn’t reliably translate to outcomes for older persons with preexisting conditions
  • With rapid treatment intervention we will have less information about vaccine efficacy for preventing severe disease
  • Squirting virus in a person’s nose is not the same as how people get infected in the real world and it’s hard to know the importance of that difference
  • Knowing that both unexplained cases of severe illness and also long-term consequences with a yet unknown duration occur in healthy young people demonstrates the risks of this approach

Cold Symptoms? COVID Testing? No Easy Answers
      There is a diversity of opinions regarding COVID testing in people whose symptoms would be quickly attributed to the “common cold” in any year other than the present. Only occasionally will the tip-off symptoms of loss of taste or smell be present. It’s easy to insist on diagnostic testing for those with fever, cough and shortness of breath but how about congestion, headache and sore throat? The article linked above helps illustrate why the answer of when to test is not always straight forward.

Wednesday Funny

Adapted from: https://twitter.com/Tburgeswatson/status/1318259532993355776 

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

 

10/14/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Dodging COVID as “Winter” Comes
      We all know crowded enclosed spaces are riskier. Here are some tips if you are indoors more to avoid wildfire smoke or cold and rainy weather or, in our case, those blistering hot and dry Santa Ana winds.
      If a member of your household has confirmed or suspected COVID, Isolation Instructions from L.A. County Public Health will tell you many things to do to reduce the risk of spread to you and other household members.
      Other simple measures include:

  • Wear your mask indoors even if you are more than 6 feet apart from other people (those aerosols can really travel)
  • Opening a window can dramatically increase air exchange rates which can help clear out virus*
  • Passengers in your car? Wear a mask, turn off “recirculate” and crack the windows*
  • Don’t put a sick person in front of a fan with other people downwind
  • Portable, plug-in HEPA air filters chosen to match a room’s size can help
  • HVAC air filters do make a difference; most home systems can handle a MERV 11 filter; go with the MERV 13 if your system can handle the “pressure drop”. Change those filters on schedule – being dirty creates more work for your HVAC. See the blog on secondnature.com for an easy intro to understanding MERV and filter performance for particles sized 0.3 to 10 microns which covers the viral aerosols you want to remove
  • Simple humidifiers may keep your nasal passages moist which may reduce your risk of infection

DON’T USE

  • Exotic air cleaners claiming to use “bipolar ionization” to break down coronavirus; they generate ozone and hydroxyl radicals which are harmful when inhaled
  • Fumigation with bleach or hydrogen peroxide or other chemicals; the concentrations you need to kill coronavirus would also be toxic to people
  • UV light; professionally engineered and installed UV systems help in hospitals but that’s not what you will be getting in portable filters; UV light can burn the skin and damage eyesight

 *Look at the Air Quality Index (AQI) before you open windows, if the AQI is <100, it is probably okay to open up. If the AQI is >150, it may be better to keep windows shut and use other measures to reduce virus; with an AQI 100-150, it depends on medical issues for those breathing the air versus virus risk.

The Aftermath of Severe COVID
      Even after surviving COVID, many patients who were critically ill face long and arduous recoveries. The problems they collect include muscle atrophy, kidney damage, reduced lung capacity, post-intensive care syndrome, fatigue, confusion, peripheral nerve damage from proning, and cognitive/psychological issues to name a few.
      With the estimate of public health experts at Harvard that millions of Americans could require intensive care before the pandemic is over, the number of COVID patients needing rehabilitation could become another public health crisis. And care delayed is care denied; the sooner COVID patients begin pulmonary rehabilitation after leaving the ICU, the faster they improve in mobility, lung capacity and muscle strength and the better their overall recovery.

COVID and the “Long Haulers”
      A long recovery is not limited to COVID patients who had severe disease. The guess is that as many as 10% of people who have had COVID could be classified as “long haulers”, experiencing prolonged symptoms (weeks, months, more?). Many of these people were never “sick enough” to need hospitalization, much less intensive care and ventilation.
      We have more questions than answers but SARS-CoV-2 may trigger long lasting changes in the immune system and perhaps in the autonomic nervous system. Dr. Fauci has noted that the brain fog and fatigue complaints of long haulers are “highly suggestive” of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There are support groups out there for long haulers that in addition to support are trying to spur research. They include “Body Politic COVID-19”, “Long Haul COVID Fighters”, and the “COVID19 Survivor Corps”.

Wednesday Funny

Adapted from a cartoon by Adrienne Hedger, www.hedgerhumor.com 

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:


Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

 

10/7/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Unintended Effects of Compassionate Use on Clinical Trials
      Trump was given Regeneron’s monoclonal antibody treatment for COVID as a result of a compassionate use request. This is not something the general public can expect to get for their COVID illness. In part, there’s not that much monoclonal antibody to go around. The main way to get this treatment at this stage in its development is to qualify for entry into a clinical trial, realizing that you might get the real drug or might get the placebo. In theory, anybody can apply for compassionate use of an investigational drug, and in fact, the 2018 Right to Try law sends those requests directly to the manufacturer and sidesteps the FDA approval that used to be required first.
      There is a downside to broad access to compassionate use. In the spring, the FDA set up a large access program for convalescent plasma and Trump promoted the treatment’s benefits. Since then, researchers have found that they have increasing difficulty enrolling participants in the clinical trials that are needed to assess its efficacy. Perhaps those potential participants didn’t like their 50-50 odds of getting the “real thing” when they can apply for compassionate use.

Failure of a Test-Only Strategy
      Beyond highlighting the limitations of testing as a sole preventive strategy, you need to know that neither the Abbott ID NOW rapid polymerase chain reaction (PCR) test (first used by the White House) nor the Abbott Binax NOW rapid antigen test (that they may currently employ) is being used in compliance with the Emergency Use Authorizations for these tests. BOTH tests are designed to be used with symptomatic people suspected of having COVID in the first 7 days of symptoms, NOT for screening asymptomatic people.
      When it comes to analytic sensitivity, the limit of detection (LoD) of these tests (i.e., the smallest number of copies of a virus in a milliliter of specimen that they can reliably detect) are orders of magnitude higher than the LoD of commonly used PCR diagnostic tests. These commonly used PCR diagnostic tests have a LoD of 100 to 7,000 copies per milliliter. The  Abbott ID NOW rapid PCR test has a LoD of 300,000 copies per milliliter. The Abbott Binax NOW rapid antigen test reports its analytic sensitivity as TCID50 which represents a viral load at which 50% of exposed cells become infected. The guess is that this translates to a LoD of ~1,000,000 copies per milliliter if the number crunching Deaconess Hospital researchers did to translate the Sofia rapid antigen test TCID50 into a LoD can be used with the Binax NOW rapid antigen test.
      The bottom line on all those numbers? You need to have a much higher concentration of virus to be found positive on the rapid tests the White House has been using. Suffice it to say, a person with a negative ID NOW test or negative Binax NOW test can already be (or go on to be later in the day) infectious even if these tests fulfill all their performance characteristics. The false negative rate may be as high as 20-50% based on those LoDs.

Obesity and COVID
      We know obesity is a risk factor for doing poorly with COVID. We know that some of this can be due to the correlation between obesity and other medical problems like high blood pressure and diabetes. We also know that obesity disproportionately affects Blacks and Latinx who are disproportionately subject to a number of other socioeconomic determinants of health such as limited access to medical care, higher representation in low wage jobs with increased exposure to the public, food deserts, crowding and a host of other inequities tied to systemic racism.
      But there also appear to be some more direct effects of obesity on physiology. From a purely mechanical standpoint, you will work harder to breath when there is more weight on your chest. Obesity also seems to increase the risk of clotting and appears to delay the immune system’s initial response and then possibly increases the chance of that response slipping into overdrive. There is also the concern that the ongoing low level of inflammation associated with fatty tissue may reduce the immune system’s ability to generate the long-lived population of “memory” cells for lasting immunity.
      The more pernicious effect of obesity on health is the tendency of healthcare providers to be more dismissive of patients with obesity, more ready to brush off worrisome symptoms as “irrelevant” side effects of their weight.

Our Fur Babies
      We have more data that cats and dogs can be infected with COVID, at least in a laboratory setting. Neither animal is likely to get sick. There is NO evidence that cats and dogs can infect humans although cats do shed the virus and have been demonstrated to infect other cats. Infected dogs do not appear to shed virus.
      On the other hand, there is very strong evidence of multiple, independent mink-to-human transmission events from a mink farm in the Netherlands.

Wednesday Funny

Created by Paul Schantz, CSU Northridge

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

9/29/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.

Part of Why COVID Usually Appears Mild in Children?
      When you are young, most every infectious agent is a new experience and a child’s immune system relies primarily on a flurry of immune activity called an “innate immune response” that is fast and overwhelming. As you age and fewer viruses are new, the “adaptive system” predominates, remembering and fighting familiar threats. It is very good at what it does, but it moves more slowly, so viruses have more time to do damage before the adaptive response gets the upper hand. And it appears that as we age, our ability to mount an innate immune response diminishes.  

The Latest Word on COVID Antibody Prevalence
      Stanford University looked at 28,500 dialysis patients across the U.S. and found that on average ~10% had COVID antibody levels. The New York metro area had values up to 25% and the western U.S. was <5%.
      While dialysis patients may have been motivated to be more careful about exposure, the CDC is due to release their own study this week based on data from commercial labs. Their study also found a ≤10% COVID antibody prevalence nationwide.

Delivery Logistics for the Genetic Vaccines
      Pfizer and Moderna both have messenger RNA vaccines in phase 3 trials. Because genetic vaccines must be shipped and stored frozen, there is a lot to prepare. Moderna’s vaccine only needs negative 20°C which is in the range your home freezer can achieve, the same as other frozen vaccines we already routinely handle. More challenging is the negative 80°C needed for Pfizer’s vaccine.
      FedEx and UPS are stocking up on freezers capable of reaching these temperatures. Pfizer has designed a special box, like a large cooler equipped with GPS enabled thermal sensors, making it possible to know where the boxes are and how cold they are so dry ice can be added as needed (somebody will have to do the babysitting).
      Corning was awarded a contract to quadruple capacity at its plant in New York to produce glass vials capable of withstanding negative 80°C and start a new plant in North Carolina as well. The dry ice needed to keep everything chilly in transport is in short supply, so UPS and FedEx are looking into making their own.
      Of course, those ultra-low temperatures needed by Pfizer’s vaccine probably means it won’t be the go-to vaccine for community clinics and mom-and-pop pharmacies.

J&J Shares its Blueprint
      J&J started its phase 3 trial for its viral vector vaccine on 9/21 and like Moderna, Pfizer and AstraZeneca earlier, they released their clinical protocol.
      Some of the pluses:

  • 60,000 participants (and will include people >60 with certain stable chronic conditions)
  • Likely a one dose vaccine (as opposed to the 2 doses for Pfizer, Moderna and AstraZeneca)
  • It needs refrigeration, not freezing, making distribution easier
  • Based on the adenovirus Ad26, used in 100,000 people without serious side effects for Ebola, HIV, RSV and Zika vaccines
  • Mild and asymptomatic COVID infection are not primary endpoints

      The reasons for caution:

  • First interim analysis at 20 cases of COVID, then weekly re-looks (see last week’s update for why frequent looks is a concern)
  • Their primary endpoint is prevention of moderate to severe/critical COVID but their definition of moderate is a positive PCR plus either shortness of breath or any 2 other symptoms of COVID; this allows for some apparently tame combinations of symptoms to count as moderate disease; What we really want to see is the reduction of severe/critical disease.

Wednesday Funny

Image Adapted from: https://i-am-fert.tumblr.com/post/626373223855112194/halt-traveler

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

 

9/23/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.

This week it’s all about the vaccines!

The Quick Recap on Vaccines in the Race
      There are 27 vaccines in phase 1 trials, 15 in phase 2 trials and 9 in phase three trials. Those phase three trials include:

  • 2 with mRNA vaccines – Moderna and BioNTech/Pfizer/Fosun
  • 3 with viral vector vaccines – AstraZeneca/Oxford, Gamaleya Institute and CanSinoBio (though CanSinoBio just made the change from a one-dose to a two-dose trial)
  • 3 are inactivated virus vaccines – Sinovac, SinoPharm/Wuhan and SinoPharm/Beijing
  • 1 is a trial of BCG (an old preventive for Tuberculosis)

A Trust Building Exercise?
       Moderna and BioNTeech/Pfizer/Fosun released roadmaps for how they plan to evaluate the safety and efficacy of the vaccines they have in phase 3 trials, followed by similar information from AstraZeneca/Oxford and there are some potentially important differences. This information is usually released only after trials have been completed but these companies appear to be feeling the need to get out in front of the public concerns over safety in the setting of accelerated development and political pressure.
     All three companies know the total number of COVID infections that must occur in the study population in order to determine with statistical accuracy that their vaccine produces at least a 50% reduction in infections (the goal set by the FDA for emergency approval of a vaccine). The power of studying tens of thousands of people is that it will take only ~150 COVID cases to reach statistical significance and possibly fewer if a vaccine is more effective than 50%. All three companies plan interim analyses of their data: AstraZeneca will do it once at 75 cases, Moderna will do it twice at 53 and 106 cases and Pfizer plans four interim analyses, the first at 32 cases. The norm in vaccine development is one interim analysis. 
     While this atypical transparency by the vaccine manufacturers is appreciated, it raises some questions. Multiple interim analyses of the data increases the odds of finding the appearance of safety and efficacy that might not hold up and can increase the risk of missing rare side effects that could be significant once the vaccine is given to millions of people if the decision is made to stop a trial early based on good interim results. There is also concern that Moderna and Pfizer intend to include relatively mild COVID cases in their case counts. Any vaccine’s efficacy would be more compelling if we knew that it reduced moderate to severe cases. It is important to not let perfect be the enemy of good, but we need to agree on what constitutes “good enough”.

Trust Building from the Government as Well?
      The FDA is reported to be days away from issuing stricter guidelines for emergency authorization of any coronavirus vaccine. Release depends on passing review by the White House Office of Management and Budget but these guidelines may include:

  • A median of 2 months follow-up of participants in late-stage trials after receiving their final dose of vaccine before emergency authorization could be considered
  • Requiring at least 5 cases of severe infection in the placebo group to assess whether vaccination lowers the risk for severe infection
  • More thorough safety follow-up of anyone receiving vaccination under emergency authorization

Waiting for the Other Shoe to Drop
     It doesn’t lessen public concerns about safety that there has been less than full information about the case of “serious neurologic illness” that briefly halted the AstraZeneca phase 3 trial earlier in September. This was the second halt – the first occurring in July when transverse myelitis was diagnosed in a study participant after her first dose of vaccine. Further study of that first case determined that the participant had previously undiagnosed multiple sclerosis as the cause of her transverse myelitis, unrelated to the vaccine, and the trial resumed.
     An anonymous source reported that this second case of “neurologic illness” has also been identified as transverse myelitis and occurred in a participant after her second dose of vaccine. Transverse myelitis can occur on its own but it is rare. Scrutiny will clearly be much more intense if a third neurologic illness develops. The FDA will not resume the US arm of the phase 3 trial without a more complete accounting of the data that led AstraZeneca and the independent data and safety monitoring board in the UK to decide that it was safe to resume.
     It is also disturbing that AstraZeneca did not “promptly” alert the FDA about the pause. Reportedly, the neurologic illness did not become known to the FDA until it was leaked after an AstraZeneca chief executive spoke with investors. If true, this does not build confidence.

Basic Preventive Measures

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT - links for free flu shot clinics we are aware of so far:
    o   City of Pasadena
    o   Huntington Hospital


Quick Links to Resources

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD

9/16/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Case and Testing Numbers for L.A. County
      L.A. County is still in tier 1 (widespread transmission) with the Blueprint update on 9/15/2020 which reflects cases and testing from 8/30-9/5. Our adjusted cases per 100,000 persons is 8.1 which is what keeps us in tier 1 for now. The Blueprint calculation of test positivity is 3.2% for L.A. County and county hospitalization numbers continue to improve. On the downside, the average daily COVID-19 deaths for the most recent week based on L.A. County dashboard numbers is 37, not our worst number but still high.
 
How Bad is That Air?
     COVID-19 has been the front-page story for months now but for the recent days, the destructive, deadly fires, and the air pollution they create have been front and center. There is a lengthy Q&A from the L.A. Times that addresses many issues, among them:

  • If you can see or smell smoke, it is better to stay indoors as much as possible.
  • Consult the Air Quality Management District (AQMD) current air quality index map to see numbers for your area; readings of 150+ mean everybody should avoid outside activities; some weather apps use a different index so be careful which numbers you compare!
  • AirNow.gov lets you put in your zip code and get the most recent air quality readings for your area.
  • While exercising early in the day or near the ocean are usually safer with respect to air quality, that isn’t really true in the current circumstances.
  • If you have window or wall air conditioning units, you want to make sure they have the best possible filter if you are using them at this time; the air in your home is cleaner than the outside and window/wall units draw air from the outside.
  • Don’t have a central air system to help clean your indoor air? There is a DIY answer for that using a box fan and a furnace filter.
  • If you are driving, put your air on recirculate; if your car has a cabin air filter (most cars within the last 10 years do), you can get a HEPA grade replacement filter and most are easy to self-install.
  • If you must be outside, masks of any kind can help but only so much.
  • The air outside isn’t good for pets either; if possible, turn them into indoor pets with short potty breaks and wipe any visible ash off their fur with a damp cloth.

     
      There is evidence that air pollution creates inflammation in the lungs (for everyone) which makes you more susceptible to COVID-19 infection. There is also evidence that after bad fire seasons, flu seasons are significantly worse. We have been pushing people to be outdoors as much as possible to reduce their risk of COVID-19 transmission but that will need to pause until the air quality is better.

Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION (but not with unfiltered outdoor air until the air quality improves)
  • GET YOUR FLU SHOT – more information about free flu shot clinics coming soon!

Quick Links to Resources

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD

 

9/9/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Blueprint for a Safer Economy
      The new state plan for reopening released on 8/28/2020 had its first numbers update on 9/8/2020. There are a lot of details about how counties can move between tiers, how to count cases and how to adjust those numbers for testing activity. There is also more to be developed for addressing health outcomes and assessing the ability to address the most impacted communities within a county. Follow the link on the Blueprint homepage for “learn more about tier assignments” for these details and a link to current adjusted numbers for counties. The state is using 10,257,557 as L.A. County’s population.

COUNTY RISK LEVEL

Adjusted cases/day/

100,000 persons

# of adjusted new cases for L.A. County/day

% positive

Tier 1 Widespread

Many non-essential indoor businesses closed

>7

>718

>8%

Tier 2 Substantial

Some non-essential indoor businesses closed

4-7

396-718

5-8%

Tier 3 Moderate

Some indoor businesses open with modifications

1-3.9

103-395

2-4.9%

Tier 4 Minimal

Most indoor businesses open with modifications

<1

<103

<2%

COVID-19 and College Towns
      There are 203 counties in the U.S. where college students make up ≥10% of the population. Half of those counties have had their worst weeks of the pandemic since August 1st and half of those have new infections peaking now.
      Makes me wonder about the ~100 counties NOT having their worst weeks since August 1st. Are they all in NY, NJ, Florida, Texas and California which peaked earlier?
 
Buckle your Seat Belts, It Could Be a Bumpy Ride
      We won’t know for ~3+ weeks which direction COVID-19 case counts in L.A. County will go and how far following Labor Day weekend. Did the beastly weather drive more gatherings inside to escape the heat making transmission easier? Was Redondo Beach a one-off or was it the face of Southern California?
      There are lots of factors that will affect where LA County cases are in the next weeks besides the Labor Day weekend but at least our average case count now is about 1,000/day lower than prior to July 4th. Let’s see where we go from here.
 
Vaccine Manufacturers Pledge
     Pfizer, Moderna, Johnson & Johnson, GlaxoSmithKline, AstraZeneca, BioNTech and Sanofi have signed a joint statement that they will not submit vaccine candidates for FDA review until their safety and efficacy is shown in large clinical trials.
 
Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation
     

Wednesday Funny

Image adapted from: https://www.pinterest.com/pin/397161260859093423/
 
Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD

 

9/2/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Welcome back to the Fall term, week 2!
 
      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.
 
General Information on COVID:
      Please see the campus wide email from Bob Blizinski from the morning of 8/28/2020 that describes how employees, students and guests can access an online questionnaire to be cleared to come on campus. For any employees, students or guests who will be on campus for work, class, picking up materials or any other purpose, this self-review should be done before leaving your home.
 
     If you report:

  • A diagnosis of suspected or confirmed COVID within the last 10 days, or
  • Close contact with a confirmed or suspected COVID case in the last 14 days, or
  • Symptoms of fever, chills or sweating, new or worsening cough, sore throat, whole body aches or vomiting/diarrhea, or
  • extreme shortness of breath, blue lips or face, chest pain or discomfort, severe dizziness or lightheadedness (these can be symptoms of COVID requiring emergency evaluation)

you will receive a red stop code from the questionnaire and be advised to get medical advice instead of coming to campus. Otherwise you will receive a green clearance code. Both codes are time-stamped and dated.
 
      Even if you are not planning to come to campus, we encourage all employees and students to do a self-review for COVID symptoms daily.  In addition to the events and symptoms mentioned above, the CDC, L.A. County DPH and PPHD include fatigue, headache, new loss of taste/smell and congestion/runny nose as potential symptoms of COVID.
 
      If you have fever with cough or shortness of breath, you are presumed to have COVID and need medical advice about testing and isolation. If you have any of the other symptoms listed above, or any symptoms that are not on the list that concern you, you need medical advice. If you have been diagnosed with suspected or confirmed COVID or have had close contact (within 6 feet for 15 minutes or more) with a suspected or confirmed COVID case, you need medical advice about when your isolation or quarantine is finished.
 
      For medical advice:

  • Students can contact their medical provider, an Urgent Care, the L.A. County COVID Medi-Nurse line at 877-409-9052 (24/7), or contact us at medicalSHS@pasadena.edu for assistance.
  • Employees can contact their medical provider, an Urgent Care, or the L.A. County COVID Medi-Nurse line at 877-409-9052 (24/7).
     
    COVID Testing Options:
          There are several COVID-19 testing options if you have new symptoms, have been told you are a suspected COVID-19 case or have been told that you had close contact with a suspected or confirmed COVID-19 case. They include but are not limited to:
    • Your medical provider
    • https://covid19.lacounty.gov/testing/ (for free testing sites, walk-up and drive-up by appointment)
    • Carbon Health Urgent Care: https://carbonhealth.com/locations (make appointments online)
      600 E. Colorado Blvd, #120, Pasadena (other locations on their website)
      They have confirmed that they can bill all private insurances (including Kaiser), MediCal and Medicare and can bill the State CARES Act for persons with no insurance resulting in no charges for the patient being evaluated and tested. See https://carbonhealth.com/insurance-pricing (scroll down for pricing). This billing information may be the same at other Urgent Care facilities, but you should ask to confirm.
       
            If you have been told that you need to isolate or quarantine, see the links for L.A. County Public Health Isolation and Quarantine Instructions below. You should continue to isolate or quarantine until you have been told that it is safe to stop by a medical professional. If you need to isolate or quarantine and there is no way to do this in your current living situation, you may be eligible for L.A. County medical housing (call 211).


Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources     

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation
     

Wednesday Funny


Image adapted from: https://boards.bordercollie.org/topic/41700-bc-working-from-home/
 
Warmest Wishes for a Safe and Successful Fall term!
 

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD

8/27/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Welcome back to the Fall term!
 
      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.
 
General Information on COVID:
      We encourage all students to do a self-review of COVID symptoms daily. For any students who will be on campus for class, picking up materials or any other purpose, this self-review should be done before leaving your home. If you have any of these symptoms or answer “yes” to either of the two questions below, you should not come to campus and should seek further evaluation as described below.

  • Fever (≥100F/37.8C) or chills
  • Cough
  • Difficulty breathing
  • Fatigue
  • Muscle pains/aches
  • Headache
  • New loss of taste/smell
  • Sore throat
  • Congestion/runny nose
  • Nausea, vomiting, diarrhea
     

This list comes from the CDC. That page on the CDC also lists the symptoms to prompt emergency care. 

There are two questions you should ask in addition to the self-review of symptoms:

  1. Have you been told that you need to isolate because you have suspected or confirmed COVID-19?
  2. Have you had close contact (within 6 feet for 15 minutes or more) with a person with suspected or confirmed COVID-19 or have you been told that you need to quarantine based on close contact with a suspected or confirmed COVID-19 case?


      If you have fever with cough or shortness of breath you are presumed to have COVID and need medical advice about testing and isolation. If you have any of the other symptoms listed above, or any symptoms that are not on the list that concern you, you need medical advice. If you answer "yes" to either of the questions about isolation and quarantine, you need medical advice about when that isolation or quarantine is finished.
 
      For medical advice, students can contact their medical provider, an Urgent Care, the LA County COVID Medi-Nurse line at 877-409-9052 (24/7), or contact us at medicalSHS@pasadena.edu for assistance.
 
COVID Testing Options:
      There are several COVID-19 testing options if you have new symptoms or have been told you are a suspected COVID-19 case or have been told that you had close contact with a suspected or confirmed COVID-19 case. They include but are not limited to:

  • Your medical provider
  • https://covid19.lacounty.gov/testing/ for free testing sites, walk-up and drive-up by appointment
  • Carbon Health Urgent Care: https://carbonhealth.com/locations (make appointments online)
    600 E. Colorado Blvd, #120, Pasadena (other locations on their website)
    They have confirmed that they can bill all private insurances (including Kaiser), MediCal and Medicare and can bill the State CARES Act for persons with no insurance resulting in no charges for the patient being evaluated and tested. See https://carbonhealth.com/insurance-pricing (scroll down for pricing). This billing information may be the same at other Urgent Care facilities, but you should ask to confirm.

 
      If you have been told that you need to isolate or quarantine, see the links for LA County Public Health Isolation and Quarantine Instructions below. You should continue to isolate or quarantine until you have been told that it is safe to stop by a medical professional. If you need to isolate or quarantine and there is no way to do this in your current living situation you may be eligible for LA county medical housing (call 211). 
 
Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources   

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

Warmest Wishes for a Safe and Successful Fall term!

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD

8/19/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Encouraging Evidence Suggesting Lasting Immunity After COVID-19 Infection
      Protection against reinfection cannot be fully confirmed until there is proof that people who encounter SARS-CoV-2 a second time are able to fight it off. The good news is that we now have more evidence that the memory T and memory B cells essential for durable immunity are produced by persons who have had COVID-19 and even in those with mild to asymptomatic cases.
 
Smoking Gun for Aerosol Transmission of SARS-CoV-2
      A University of Florida research team succeeded in isolating culturable live virus from the air in a room for 2 patients in a ward dedicated to COVID-19 cases. Neither patient in the room had been subject to any medical procedures known to produce high levels of aerosols. The volume of virus collected was small but knowing that it was collected at 7 and 16 feet away from the patients and in a room with all the engineering enhancements to eliminate the virus (6 air changes/hour, efficient filters, UV irradiation and more) makes an even stronger case for “keep your mask on indoors”
 even if you are more than 6 feet away from others who are not part of your household.
 
A Breakthrough in PCR Testing?
      Yale University was given an EUA for their SalivaDirect test that was developed in part with funding from the NBA and the NBA Players Association. They recognized that SARS-CoV-2 in saliva did not require preservatives or specialized collection tubes and that processing the specimens with a simple proteinase and heat treatment eliminated the need for more expensive and time-consuming nucleic acid extraction techniques. Plus using saliva meant no more uncomfortable nasopharyngeal swabs. So SalivaDirect offers cheap and easy specimen collection and preparation but you still have to pay for it to go through the polymerase chain reaction (PCR) testing process.
 
Could the Answer be in the Sewer?
      How much COVID-19 does a community have? If you are trying to answer this by testing individuals, you need to test a lot of people – asymptomatic as well as symptomatic – and you may want information from multiple points in time to track the rise and fall of the virus.
      Sewage Chemical Information Mining (SCIM) is a technology that is already used to estimate community levels of opiate use, tobacco and pesticide exposure. Looking at levels of SARS-CoV-2 in the “sewersheds” of communities may be another way to track prevalence of disease.


Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)


Quick Links to Resources

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up testing sites, all by appointment: https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

 

8/12/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Rate of Asymptomatic Infection
      In another large study from South Korea, there is more data to suggest that persistently asymptomatic COVID-19 infections may be more common than we originally thought. There were 303 people isolated at a community treatment center after testing positive for SARS-CoV-2 by PCR. Of those people, 110 were asymptomatic on admission and 89 of that 110 (29% of the 303) continued to be asymptomatic throughout their stay. All persons had multiple PCR tests and were not released until they had a negative test. There was also no significant difference in the viral load of the symptomatic and asymptomatic persons (as evidenced by equivalent cycle thresholds for PCR tests).
      Since asymptomatic people are not coughing and sneezing, you can hope that they might infect others less frequently. The flip side is that because they don’t feel ill, they will continue their usual activities, producing respiratory droplets and aerosol particles with breathing and talking that can transmit SARS-CoV-2. This reinforces the need to wear your mask, social distance and wash your hands no matter how normal you or the people around you feel.
 
 
Indirect Evidence that Masks Reduce Viral Dose Which May Reduce Severity of Illness
      We know from previous studies of influenza virus that even simple masks can reduce the dose of virus inhaled and that the dose of influenza virus exposure makes a difference in severity of illness. Nobody would agree to do the same dose-of-exposure trials for SARS-CoV-2 virus in people but there are animal studies and indirect evidence that masks reduce infection rates and that lower exposures may result in milder disease.
      Regarding milder disease as a result of lower exposure, of the 634 persons on the Diamond Princess cruise ship in February with a positive PCR test, 80% were symptomatic whereas of the 128 PCR positive passengers on an Argentinian cruise in March, only 20% were symptomatic. The passengers of both cruise ships were quarantined in their cabins when illness was recognized but the Argentinian passengers were also given masks to wear after the first person became feverish. With what we know now, no one could in good conscience do a randomized trial of mask versus no mask.
 
 
When the News is About How the Numbers are Reported, You Know that Isn’t Good
      Nobody wanted to hear last week that there were an unknown number of COVID test results in the California Reportable Disease Information Exchange (CalREDIE) that haven’t been reported due to a computer “glitch” of unknown duration. Labs processing tests send reports to the state and then the state sends numbers to the counties. Dr. Mark Ghaly, California’s Health and Human Services director was quoted on 8/10/2020 saying the glitch involved 250,000 to 300,000 test results and that the problems are fixed, and the backlogged data has been shared with county health officials. But when you look at the L.A. County COVID dashboard on 8/11, they say they are still waiting to hear about backlogged results. Apparently the CalREDIE runs on technology that was as antiquated as the systems used in the DMV and Employment Development Department.  
 
 
What We CAN Say About the L.A. County Numbers
      We won’t know until later how many of those backlogged tests are cases in L.A. County but at least the numbers we DO have are showing slow improvement with daily average new cases of 2,364 for 8/5-8/11. Sadly, our case positivity rate for 8/5-8/11 is still a depressing 11.3%. The percentage change in hospitalization and ICU numbers for L.A. County and the state are definitely improving (at low and near double digit rates over the past week) and the numbers of hospitals reporting that data has almost stabilized after reporting was switched from the CDC to the federal Health and Human Services Department in mid-July.
 
What We All Want to Be Able to Say

Image adapted from: https://makeameme.org/meme/goodnight-moon-goodnight-9a0861b903

Basic Preventive Measures
      In an article about how the U.S. has gotten to where it is with COVID-19, Dr. Thomas R. Frieden who ran the New York City Health Department and the CDC. for a combined 15 years observed, “This isn’t actually rocket science, we know what to do, and we’re not doing it.” The things we know we can do include:
        WASH YOUR HANDS                              MAINTAIN SOCIAL DISTANCING
 
             WEAR A CLOTH FACE MASK                   ISOLATE/QUARANTINE WHEN INDICATED
 
                      CHOOSE GREAT VENTILATION                GET YOUR FLU SHOT
 
 
Quick Links to Resources

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up   testing sites, all by appointment: https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
         ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
         ph.lacounty.gov/covidisolation


 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

 

8/5/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Faster, Cheaper Testing
      We know that PCR testing has been the diagnostic test of choice and we know that nasopharyngeal specimens have been the specimen of choice. We know that the limit of detection (which translates to sensitivity) of PCR tests can vary a lot. We have known for months that people do not like the collection process for nasopharyngeal specimens. We continue to be painfully aware of the challenge of keeping up with the supply of swabs, reagents and PPE for collecting and running these tests and the overall cost of PCR testing. And everybody knows that days spent waiting for results invariably results in increased transmission unless people are willing and able to fully isolate.
      Columbia University is working on a saliva-based test that can produce results in 30 minutes that has a sensitivity and specificity comparable to good PCR tests using a modification of the loop-mediated isothermal amplification process (LAMP) that doesn’t require special equipment. A test like this could be inexpensive enough to do every day to identify people (many of them asymptomatic) who need to isolate. Let’s hope it moves from pre-print to reality soon.
 
Children and COVID
      There is some preliminary evidence that children under 5 may have up to 100 times the viral load of adults. It was only a small study and detecting virus by PCR is not the same as proving that it can infect others (something this study was not designed to address) but along with the South Korea study documenting transmission in children, it will move the needle of opinion about COVID and children.
      In the category of better to learn from the experience of others, an overnight summer camp in Georgia opened up on 6/21/2020 with 363 campers and 261 staff. Everybody had a negative coronavirus test no more than 12 days before arriving at camp and there was enhanced cleaning, physical distancing outside of cabins, staggered use of communal spaces and staff were required to wear cloth face coverings when with campers. The campers were not required to wear masks (this was Georgia), windows and doors were not opened in buildings to increase ventilation and, as usual, the camp experience included a lot of loud singing and cheering. One teen staffer left sick on 6/23/2020 and had a positive COVID test on 6/24/2020, some campers were sent home sick by 6/24/2020 and the camp was closed on 6/27/2020. Results of COVID testing were available for only 344 out of the total of 624 campers and staff but 76% of those tests were positive.
 
A Peek at Colleges and Universities
      The New York Times has launched an attempt to gather outbreak information from colleges and universities, something that has not been presented as separate data on county/state/federal dashboards. They have started small (public 4-year plus private 4-year schools either in Division 1 sports or a member of the Association of American Universities). They hope to expand the data base over time and include other 4-year and 2-year colleges. The data shows 6,600 COVID cases linked to U.S. colleges (before fall classes). Perhaps most disturbing is how many of the colleges contacted so far said that they were either not tracking COVID cases or declined to share aggregate, anonymized data. You can see a list of the schools that provided case information that plan to have fall classes “primarily or fully in-person” includes 7 colleges reporting 50 cases or more.
 
Basic Preventive Measures We All Still Need
     
WASH YOUR HANDS                              MAINTAIN SOCIAL DISTANCING
 
          WEAR A CLOTH FACE MASK                   ISOLATE/QUARANTINE WHEN INDICATED
 
                        CHOOSE GREAT VENTILATION                GET YOUR FLU SHOT
 
 
Quick Links to Resources  

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up testing sites, all by appointment - https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
              ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
              ph.lacounty.gov/covidisolation

 
 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD
   

 

7/29/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Waning Antibodies After COVID-19 Do Not Necessarily Mean Risk of Re-infection
      Don’t let the King’s College of London report of quickly waning COVID-19 antibodies convince you we are doomed. There’s more to immunity than antibody levels alone. We haven’t been measuring the T helper, T killer, memory T and memory B cells that are potent factors in on-going immune response.
      What about those reports of people diagnosed with COVID-19 seeming to recover only to later develop new symptoms and a positive PCR test? They appear to be anecdotes without confirmation of reinfection, as evidenced by the lack of recoverable live virus or transmission to others.
    
When We Get a Vaccine, Who Gets it First – Part 2
      In the 7/15/2020 COVID-19 Update we discussed the demographic factors being considered in how to equitably distribute the initially limited supply of vaccine.
      We are getting a trial run of achieving equity in the distribution of a scarce commodity with remdesivir which has been identified as a promising treatment for COVID-19. Its supply is far outstripped by the number of COVID-19 patients that might benefit from its use. The University of Pittsburgh developed a weighted lottery to prevent haphazard and inequitable distribution of their limited supply of remdesivir. They added weight for patients from disadvantaged communities and for essential workers and subtracted weight for patients expected to die within a year from a chronic end stage condition. Because allocation of the drug within the subgroups identified by the weighted factors is randomized, it becomes possible to follow that subgroup as a randomized controlled clinical trial and make measurable assessments of the benefit of remdesivir for that subgroup, something that was not possible in the prior clinical trial of remdesivir.
 
We’ll Take Improvement Where We Can Get It But Will We Be Able to Keep It?
      The numbers in L.A. County were better this past week in that the average number of new cases per day is 2,467/day compared to 3,108/day in the preceding week. Unfortunately, some of this drop in cases may be related to a concurrent drop in testing. With 116,000 tests in the past 7 days (a 30% drop from the ~170,000 tests per week in the two weeks prior) the percent positive rate is 14.9%. You want that number well below 8% and closer to 3% if you are trying to flatten and then bend the curve of COVID-19 infection. The hospitalization data for L.A. County appears to be improved, though with the changes made in reporting, there is data missing on both the county and state level.
 
Basic Preventive Measures
    The fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING – as many as half the people who can “give” you COVID-19 won’t look sick
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge that is form fitting under the chin
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case
  • CHOOSE THE OUTDOORS OR ROOMS WITH GREAT VENTILATION in addition to social distancing and masks when with people outside of your household
  • GET YOUR 2020-21 INFLUENZA VACCINE when it becomes available later this summer

Quick Links to Resources

 
 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

7/15/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

An Update on the Vaccine Race
            There are  4 vaccines that have started phase 3 (efficacy) trials: the viral vector vaccine from Astra Zeneca, the killed virus vaccines from Sinopharm and Sinovac, and the “repurposed” BCG vaccine being studied by Murdoch Children’s Research Institute. Moderna is still expected to get phase 3 trials of its messenger RNA vaccine going in July.
 
When a Vaccine is Available, Who Gets it First?
            It will take time to make enough vaccine for everybody who needs it. Normally the CDC makes recommendations about the use of a new vaccine and state/local public health decide whether to follow those recommendations. The Advisory Committee on Immunization Practices (ACIP) routinely advises the CDC regarding implementation of new vaccines. ACIP has started discussing how underlying conditions, living environments, occupational risks, ethnicity and race should be weighed in allocating the initially limited supply of vaccine. They anticipate public meetings later this summer and involving communities being considered in its deliberations.
 
If We Have a Vaccine, Will People Accept It?
            All the talk of accelerating vaccine production along with societal wrangling over COVID-19 is likely to make many people less confident in choosing to accept a vaccine when it is available. The BIPOC (Black, Indigenous and Persons of Color) communities have experiences that support distrust of American government, society, healthcare and medical research. Dr. Phoebe Danziger, a pediatrician at University of Michigan summarizes it well in saying “sufficiently widespread vaccination will be possible only if the values and goals of a vaccine program are discussed explicitly, transparently and early, and if that discussion includes the full range of voices that have been telling us for years that trust in the American institutions and systems responsible for vaccines is broken”.
 
Who Will Be in those Phase 3 Trials?
            The communities at increased risk of infection and death from COVID-19 will need to see their communities reflected in all phases of vaccine trials to help address the questions of safety and efficacy for their communities. The COVID-19 Prevention Network (CoVPN) is a merger of four existing NIAID (National Institute of Allergy and Infectious Disease) funded clinical trials networks to leverage existing infrastructure and engage communities to secure the thousands of volunteers needed for late-stage clinical trials of promising vaccines. “Centralizing our clinical research efforts into a single trials network will expand the resources and expertise needed to efficiently identify safe and effective vaccines and other prevention strategies against COVID-19” (Dr. Fauci). People interested in participating in vaccine trials can get more information at www.coronaviruspreventionnetwork.org.
            Human challenge trials deliberately expose participants to infection, in order to study diseases and test vaccines or treatments. www.1daysooner.org is recruiting volunteers for COVID vaccine challenge trials. Before you dismiss this approach, you should look at the estimate of benefits and risks presented on this web site.
 
Basic Preventive Measures
The fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case
  • Let’s add CHOOSE THE OUTDOORS OR ROOMS WITH GREAT VENTILATION when with people outside of your household
  • And don’t forget to GET YOUR 2020-21 INFLUENZA VACCINE when it becomes available later this summer

  
Quick Links to Resources

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 

 

7/8/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Watch Out for Methanol-Based Hand Sanitizers
Los Angeles Health Alert Network passed along advice from the CDC to avoid using methanol-based hand sanitizers, some of which is manufactured by “EskbiochemSA de CV”. While methanol most frequently causes death and blindness by swallowing it, repeated application to the skin also appears to be dangerous. The signs and symptoms of methanol poisoning include headache, blurred vision, blindness, nausea, vomiting, abdominal pain, loss of coordination and decreased alertness. There is a list of products that have been recalled.
 
Thinking About Air Travel?
If you are thinking about flying inside the U.S., be aware that many states have travel restrictions in place requiring a 14 day quarantine for not only international travelers but also domestic travelers. If you have your heart set on a trip to Europe, you should think twice. The U.S. State Department advises U.S. citizens to avoid all international travel and as of July 1, residents of the U.S. are not on the list of persons allowed to enter the European Union unless they qualify for an exemption.
 
Home Testing for COVID-19?
What if testing for COVID-19 was easy like a home pregnancy test AND cheap? With cost estimates of $1-$5 per test, there is a clear financial incentive. The devil, as always, is in the details. These rapid antigen tests (both home and outpatient office) detect proteins of the SARS-CoV-2 virus with results in approximately 15 minutes. They are less sensitive than the molecular polymerase chain reaction (PCR) diagnostic tests so a negative rapid test in a person with symptoms should be followed by a PCR test. For a cautionary review of these tests, read what the Association of Public Health Laboratories has to say.
 
Weighing the Risks of an Activity?
You are trying to make good decisions, trying to weigh the risks and benefits of your actions. But what you need to know is that the deck is stacked against you when it comes to evaluating your personal risk. Knowing more about optimism bias, confirmation bias, exposure therapy and the confusion created by high levels of public disagreement may help you keep things in perspective.
 
Wednesday Comic
 
Image adapted from: https://www.stairwaytoevan.com/drawing-1
 
 
Basic Preventive Measures
Boiling it down to the fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case


Quick Links to Resources

  • Interactive map showing 63 drive-up and 29 walk-up testing sites, all by appointment; if you are looking for a test because you had a risky exposure or because you have symptoms, you need to quarantine/isolate until you have your results:

          o   https://covid19.lacounty.gov/testing/

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

7/1/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

The “Read’em and Weep” Numbers and Words
          L.A. County averaged 2,211 new cases per day over the past 7 days; that number was 1,281 for the period of 6/3-6/9 and 799 for the period of 5/6-5/12.
          The percentage of tests done over the past week that were positive was 12.1%; you want to see 8-10% if you are trying to “flatten” the curve (mitigation) and ≤3% if you are hoping to bend the curve back to zero (suppression).
          In the past 7 days there was a 19% increase in suspected and confirmed COVID hospitalizations and an 8% increase in suspected and confirmed COVID ICU patients compared to the preceding week.
          The only California County Variance Criteria L.A. County is meeting in the past 7 days is in numbers of tests per 1,000 persons per day but before you start feeling too good about that, I recommend you read an article about the total number of tests California needs to be doing based on current infection rates to flatten (mitigation) or bend (suppression) the curve of COVID cases according to Harvard Global Health. When you are done with that one, read the one from The Atlantic about how the U.S. is once again outstripping its testing supply just when surging cases mean that testing really needs to increase dramatically further.
 
Isolation and Quarantine, When Do They End?
          Last week we referred you to the L.A. County Department of Public Health instructions for Isolation and Quarantine. Follow this week’s links to see that you can choose from 13 languages for a pdf version.
          The second page of the Isolation Instructions has boxed information for when your isolation period ends.
          Defining the end of quarantine is more nuanced. If you have a positive nasal or oral swab test OR if you develop symptoms compatible with COVID-19 during your quarantine, you switch to the isolation instructions. The quarantine instructions cover five different scenarios for calculating an end to quarantine (at the end of the document). If you are still uncertain about when your isolation or quarantine can end, ask your local Public Health Department.
          At the current rate of new cases, more of us will likely end up in isolation or quarantine and knowing how to do it correctly (and quickly) will be the only way for our community to emerge from the hole we are digging.
 
Some of the Story Behind “Toilet Plume” and Fecal SARS-CoV-2
          People studying infectious disease have known about “toilet plume” at least since 1950. A review article from 2012 tells how toilets create an eruption of bioaerosols with flushing that can remain suspended in air for hours and how subsequent flushing continues to produce the same bioaerosols even if no further bacteria has been added. It won’t make you feel better when they tell you that “the most significant toilet plume airborne infections are likely to be due to viruses”. When you follow the lead to read about the SARS outbreak in the Amoy Gardens apartment complex in Hong Kong in 2003 (if nothing else, read the discussion at the end), you will realize that you want to know more about the SARS-CoV-2 virus that has been detected in the stool of some COVID-19 patients.
           The best review of the potential for fecal transmission of SARS-CoV-2 that we found reminds us that it is only a subset of COVID-19 patients who have had virus detected in their feces. Detecting the SARS-CoV-2 virus in feces is not the same thing as documenting the ability to infect other people. The 14 studies summarized are hampered by varying combinations of small numbers, methodology and short follow-up. There were only three reports of virus that could be grown among these 14 studies.
          Before you vow to never use another shared restroom, the overwhelming evidence is that respiratory droplets are the primary route of transmission for SARS-CoV-2; that delightful group meal in a restaurant or that drink in a bar with three of your closest friends is hands down the easiest way for you to get COVID-19. Still, this review prompts us to push for:

  • Wear your cloth face mask when using shared restrooms, it doesn’t stop everything but it is definitely better than nothing.
  • Continue aggressive public health messaging about hand washing.
  • Frequent cleaning for touch surfaces in shared restrooms.
  • Great ventilation in shared restrooms.
  • Lids for our toilets and the presence of mind to close them prior to flushing.
  • If there is a drain in a restroom floor, make sure the water trap has water in it.
  • A lot more data about how long and in whom infectious virus appears in the stool to make the necessary recommendations about the use of shared restrooms.
     

Basic Preventive Measures
Amazingly, these are still the tools you can use to protect yourself and others:

  • WASH YOUR HANDS; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you or they are sick; disinfect high touch surfaces frequently; MAINTAIN SOCIAL DISTANCING.
  • WEAR A CLOTH FACE MASK when out in public until the CDC, state and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine. 


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD
 

 

 

 

6/25/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Update on Testing to Diagnose COVID-19 in L.A. County
          To diagnose COVID-19 based on test results, you need a Polymerase Chain Reaction (PCR) test done on a nasal or oral swab specimen. The preferred approach to diagnostic testing is to get it done through your insurance/primary care provider so that you are already hooked up with someone to help you interpret the results and advise you on next steps. If you cannot contact your provider or do not have health insurance, there are ~98 sites for testing in L.A. County that you may be able to use. Some of these (22) are operated by L.A. City and County, some are OptumServe sites set up by the state (8), some are associated with Project Baseline, a project of Verily (3) and some are part of the growing list of CVS pharmacies, various community health centers and city level testing (e.g. Baldwin Park, Carson, etc.) and other providers (65 sites).
          All of these sites offer free testing to persons who meet the criteria for testing. If you have insurance, these sites will collect information to bill your insurance to collect reimbursement with no co-pay or deductible costs for you. If you do not have insurance, the state will be billed for the test and you will not have any expenses. Some of these sites are drive-up only, some walk-up only and some do both. All of these sites do testing by appointment only. If you are using the interactive map to find testing sites, there are test site addresses, phone numbers and links for making an appointment.
          Have family in California outside of L.A. County? There is a state level interactive map that includes OptumServe sites, Verily sites and a long list of community sites.

Information You Need if You Have Been Tested or Are Considering Testing
          If you are doing PCR testing because you have had symptoms (fever, cough, shortness of breath, chills, muscle pain, headache, sore throat or new loss of taste or smell), you should follow L.A. County Isolation Instructions while you arrange for testing and wait for results.  If you are doing testing because you were told you had close contact (within 6 feet for 15+ minutes) with a person with confirmed or suspected COVID-19, you should start following the  L.A. County Quarantine Instructions at the time you are told that you are a close contact.
          These instructions include information about when your isolation or quarantine can end. If you are on quarantine, a negative PCR diagnostic test does NOT mean that your quarantine can end sooner. Too much is still unknown about antibody testing for it to modify isolation or quarantine instructions.

The Word on Masks From the California Department of Public Health
          If you missed it, the California Department of Public Health published statewide guidance for the use of face coverings on 6/18/2020. That guidance calls for cloth face coverings anytime you are away from your home unless you are outside and can count on being able to stay more than 6 feet away from other people who are not part of your household. Notice that if you are unable to wear a cloth face covering due to a medical condition and your job puts you in regular contact with other people, you should wear a face shield with a drape on the bottom edge if physically able. 


Basic Preventive Measures

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC, state and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

 

 

 

6/17/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Review of Vaccine Development for COVID-19
          The race has been on since January to develop vaccine(s) for COVID-19. Ideally, there will be multiple successful vaccines to make widespread production easier and to hedge our bets when it comes to the ongoing safety and efficacy. As of early April, there were at least 60 vaccine candidates being developed around the world and that number is probably closer to 120 now. There are five vaccine candidates currently being expedited with financial support from the U.S. being developed by Moderna, Oxford/Astra Zeneca, Janssen (J&J), Sanofi and Merck.

    There are basically four different categories of vaccines.

  • Whole virus vaccines to stimulate the immune system to produce antibodies to attack live versions of the virus in the future, with either a killed or a live attenuated virus.
  • Protein-based vaccines to produce antibodies in the same way that whole virus vaccines do but only require introducing a protein, not the entire virus. Sanofi is developing a recombinant protein vaccine.
  • Viral vector vaccines use a virus that enters cells easily to deliver a gene to produce a COVID-19 protein (usually the spike protein) to illicit an immune response; the vector virus is either harmless or has had its genes modified to eliminate its multiplication inside the cell. Oxford/Astra Zeneca, Janssen (J&J) and Merck are developing viral vector vaccines.
  • Genetic vaccines deliver DNA or messenger RNA (mRNA) to produce a COVID-19 protein to illicit an immune response without the use of a vector virus. Moderna and Sanofi are developing mRNA vaccines.

       Each of these four types of vaccines have their own strengths and weaknesses. A significant caution with genetic vaccines is the fact that this is a totally new method of vaccine production without a history of prior use to illuminate pitfalls.

       Vaccines go through several phases of development. They all have a preclinical phase that ends with animal trials and leads to the clinical trials:

  • Phase 1 – Small scale human trials to assess safety and dosage of the vaccine relative to immune response.
  • Phase 2 – Larger human trials to assess efficacy and side effects.
  • Phase 3 – Human trials with hundreds to thousands of persons across multiple sites to evaluate the efficacy under natural disease conditions.
  • Phase 4 – After a vaccine is licensed and introduced, on-going surveillance is done to look for rare side effects and assess long term efficacy.

        The usual timeline for development of a new vaccine is 4+ years minimum. Multiple steps are being taken to attempt to compress this timeline. We know from previous SARS, dengue and HIV vaccine trials that rarely, viral vector vaccines can trigger antibody-dependent enhancement, which makes recipients more susceptible to infection rather than less. You can try to speed up the vaccine research with “challenge trials”. Normally, it is unethical to challenge someone with a disease for which there is no cure (as with COVID-19) but the counter argument is that a challenge trial may be more ethical than leaving large populations vulnerable for a longer time.

        Mass production of successful vaccines is the next bottleneck. American vaccine plants typically produce 5 to 10 million doses of routine vaccines per year. For SARS-CoV-2, the U.S. may need 300 to 600 million doses of vaccine, syringes, alcohol wipes, glass vaccine vials, etc. The U.S. is attempting to build the manufacturing capacity in parallel to the vaccine development and to put the Defense Department in charge of logistics. When the vaccine is available, the only ethical choice is to make it available to all regardless of insurance or ability to pay.

Dose of Exposure Matters
          The number of viral particles in an exposure appears to be key in the likelihood of successful transmission of COVID-19. While large respiratory droplets fall to the ground quickly, the much smaller aerosol particles created with breathing, speech and coughing remain airborne longer and have been shown to contain viral particles which can remain viable and infectious. We don’t yet know how many viral particles are required for infection, but the SARS-CoV-2 virus is similar to the SARS virus for which the estimated infective dose is just a few hundred particles. Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow, and timing. Increasing ventilation reduces risk and while surgical masks are only ~30% effective at reducing aerosol particles inhaled by the mask wearer, they are much better at reducing the aerosols generated by exhaling and speaking.

  • If you are in a room with people not from your household, in addition to keeping 6+ feet distance, you should continue to wear your mask to reduce sharing aerosol particles.
  • You should choose rooms with as much ventilation as possible when with persons outside your household or go outside in addition to maintaining social distancing.

Basic Preventive Measures
These are still the tools you can use to protect yourself and others:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

6/11/2020 Coronavirus Update
 

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

A Mask to AVOID if You Care About Others
         For the sake of those around you, watch out for those masks (N95 or other) with non-filtering one-way exhaust valves in the front. Not only do they fail to filter out the droplets and aerosols created by the wearer speaking and exhaling, but the funnel effect of the exhaust valve likely means that those unfiltered droplets and aerosols are propelled with even greater velocity (and stay airborne further and farther) than if there was no mask at all.

Pasadena Public Health Department Guidance
          Pasadena Public Health has released written guidance for colleges and universities for the return of students to campus in Stage 3 but they continue to develop their Reopening Protocol for Office Workspace which includes measures to protect those who work on campus during Stage 2 while students are still remote.

L.A. County by the Numbers
          The average daily new COVID-19 cases fell for the first time compared to the previous four weeks to 1,281 new cases/day for the week ending 6/9 (average 1,360 new cases/day for the preceding week) but L.A. County is still far above the cutoff of 180 new cases/day set by the 5/18 County Variance Criteria. With 10.3% of tests positive for the week ending 6/9, L.A. County also failed to meet the <8% cutoff for the alternative method of satisfying the criteria regarding new cases. It is difficult to know how much each of these changes are due to the 31% drop in numbers of tests performed compared to the previous week or rising prevalence of disease or both.
          There were 1.23 tests/1,000 persons/day in the week ending 6/9 which no longer meets the variance criteria of 1.5 tests/1,000 persons/day.
          COVID-19 hospitalizations in L.A. County are unchanged for the week ending 6/9 while they had been dropping 2-3% in each of the two preceding weeks. COVID-19 ICU patient numbers are down 3.5% over the previous week.
          We are hoping that testing volume returns to the sort of numbers that will allow us to assess the presence of infection more accurately.

Basic Preventive Measures
These are still the tools you can use to protect yourself and others:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


 

 

6/3/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Dose of Exposure Matters
          The number of viral particles in an exposure appears to be key in the likelihood of successful transmission of COVID-19. While large respiratory droplets fall to the ground quickly, the much smaller aerosol particles created with breathing, speech and coughing remain airborne longer and have been shown to contain viral particles which can remain viable and infectious. We don’t yet know how many viral particles are required for infection but the SARS-CoV-2 virus is similar to the SARS virus for which the estimated infective dose is just a few hundred particles. Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow, and timing. Increasing ventilation reduces risk and while surgical masks are only ~30% effective at reducing aerosol particles inhaled by the mask wearer,  they are much better at reducing the aerosols generated by exhaling and speaking. This sort of data leads me to think that:

  • if you are in a room with people not from your household, in addition to keeping 6+ feet distance, you should continue to wear your mask to reduce sharing aerosol particles.
  • you should choose rooms with as much ventilation as possible when with persons outside your household or go outside in addition to maintaining social distancing.
     

Crises Exacerbate Inequities

          The COVID-19 pandemic, like all crises, amplifies longstanding inequities in housing, employment, transportation, income and healthcare access that go on to function as multipliers resulting in higher rates of infection and/or death in communities that experience those inequities. In California, this is most apparent for African Americans and Latinos.


L.A. County Numbers Compared to 5/18/2020 State County Variance Criteria

          The average number of new COVID-19 cases has been rising over the last four weeks, 1,360/day for the week ending 6/2 and 1208, 940 and 799 for the three preceding weeks. Despite these high numbers of cases, L.A. County still meets the County Variance criteria based on testing numbers that result in a percentage of positive tests of 7.5%, below the 8% cut off. This is up from 5.4% the previous week.

          There were 1.8 tests/1,000 persons/day in the week ending 6/2, down from 2.2 the previous week, but still better than the 1.5 tests/1,000 persons/day criteria. 

           COVID-19 hospitalizations in L.A. County declined 2% over the previous week. Hospitalizations and deaths tend to lag behind cases by 2-3 weeks.

Basic Preventive Measures

These are still the tools you can use to protect yourself and others:    

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

5/27/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Contact Tracing
        As society re-opens, we will need to continue our basic preventive measures to reduce the transmission of COVID-19. The only way it will be reasonable to continue re-opening is if we can manage to have at least stable, if not ideally, steadily decreasing numbers of new cases – something that has not happened in L.A. County yet. In the absence of a preventive medication or an immunity generating vaccine, decreasing cases will happen only if we are diligent about finding new cases (that’s the role of abundant testing), isolating new cases to prevent spread to others and rapid identification of close contacts of cases for testing and quarantine.
         For an in-depth look at contact tracing, consider reading Tomas Pueyo’s third installment of “Learn to Dance”. If your brain is already hurting knowing that it is a 40 minute read, here is a 1,500 word summary that hits the high points.
         If you look at Wuhan style manual tracing at its fastest, the guesstimate is that it takes about 5 person-days per case (one person working 5 days to assess one case or 5 people working 1 day to assess one case). If you were attempting to get 70-90% of the contacts for all of each day’s new cases contacted and quarantined within 2 days and you were working with 180 new cases each day you would need 450 people in L.A. County working extraordinarily hard doing contact tracing 7 days a week.
         Why are we suggesting 2 days to assess a case? Because that is the minimum speed needed to reduce transmission. Why are we saying 180 new cases each day? Because that’s the target of the 5/18/2020 County Criteria for L.A. County. For the past week, L.A. County is averaging 1208 new case per day. For those numbers, you would need over 3,000 contact tracers working 7 days a week. This manual approach is heavily dependent on the cooperation and memory of the initial infected person as well as the accessibility and cooperation of the contacts of that infected person.
          There are ways to make contact tracing faster, easier and more accurate but it takes being willing to access GPS data, mobile phone location data, credit card location data and closed circuit TV. And it could include Bluetooth identification of contacts. This only helps if most people keep their Bluetooth enabled device with them and turned on and don’t opt out. People can argue about privacy but if you are trying to avoid a reapplication of “The Hammer” in order to control disease you might decide the trade-off is worth it.

California Connected
          Hot off the presses, Governor Newsom announced “California Connected” on 5/26/2020, a plan to put 10,000 trained contact tracers to work across the state. Their job will be to “connect with individuals who test positive for COVID-19 and work with them, and with people they have been in close contact with, to ensure they have access to confidential testing, as well as medical care and other services to prevent the spread of the virus.” They do not ask for financial information, social security numbers or immigration status. Additional information is available at California Connected.
          If California Connected is trying to reach you, you should see “CA COVID TEAM” on your caller ID, your text message, or your email.

Answer your phone, email and text messages if you see CA COVID TEAM is reaching out!

Basic Preventive Measures
Everything you have been doing all along is still important:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

 

5/20/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

New state criteria for moving forward in reopening
The Regional Variance Criteria announced on 5/7/2020 by Governor Newsom have been revised as of 5/18/2020. Some of the changes seem clearly necessary (zero deaths from COVID-19 over 14 days would have been unachievable for a long time in L.A. County) and some seem like deciding to move the goal posts when you are unhappy with your current position.  The revised County Criteria cover many of the same issues in the Regional Variance Criteria but is longer and introduces some new measurements in assessing a county’s readiness to reopen sectors and spaces that are part of the State’s plan for Stage 2. Reopening colleges and universities is part of Stage 3 which these criteria are not intended to address. Here’s what we can tell you about the similarities and differences between the Regional Variance Criteria and the revised County Criteria and what the L.A. and Pasadena numbers look like at this time: 

5/7/2020 Regional Variance

5/18/2020 County Criteria

Cases

≤1 case/10,000 persons/14days

 For L.A. County that is 1010 cases/14 days
For Pasadena that is 14 cases /14 days

≤25 cases/100,000 persons/14 days 
(which is ≤2.5/10,000 persons/14 days)

For L.A. County that is 2,525 cases/14 days
For Pasadena that is 35 cases/14 days

Or less than 8% testing positive in last 7 days

L.A. County had 12, 629 cases for the 14-day period of 5/5-5/18.
L.A. County had 9.4% of tests positive for 5/11-5/17.
Pasadena had 250 cases for the 14-day period of 5/5-5/18.
No testing data for Pasadena. Unable to calculate % of tests positive.

Testing

≥1.5 test/1,000 persons/day

≥1.5 test/1,000 persons/day and disclose avg daily testing volume for past 7 d or make case that less testing is indicated AND testing available for 75% of residents within 30-min drive time (private and public testing)

L.A. County had an average of 0.98 tests/1,000/day for the week of 5/11-5/17.
PPHD does not post testing numbers, only cases, deaths and demographics of cases and deaths.
It is unclear whether L.A County currently or in the future will have testing available to 75% of residents with ≤30 minute drive and L.A. County Public Health has suggested that the regional free testing sites will be shut down by fall.

Deaths

No COVID deaths in last 14 days

Stable hospitalizations of COVID on 7 day average with <5% change                     
                   -OR-
No more than 20 COVID hospitalizations on any single day in the past 14 days

L.A. County had 611 deaths for 5/6-5/19, Pasadena had 13. It looks like the revised criteria will use hospitalizations instead of deaths. We haven’t been tracking the hospitalization numbers but we will start. 

July 4th as a goal for being more open in L.A. County
The L.A. County Board of Supervisors meeting on 5/19/2020 announced a goal of being more fully open by July 4th (free subscription for COVID news) where "more fully open" most likely means being farther into Stage 2 of reopening. Dr. Barbara Ferrer was quoted as saying "...we are going to really aim to get there as quickly as possible but we are going to pay attention to the data and science". Public Health follows the "R" for infectious diseases which represents how many new infections will occur for each identified infection (aka the effective transmission rate). The R for COVID-19 was 3.5 in March before the stay-at-home order and the R is now at 1 with the stay-at-home order. Time will tell us whether our R number stays low as we move about more.

How to get a test
We have said it before but it bears repeating, if you don't have health insurance you can still get free diagnostic testing in L.A. County by going to corona-virus.la. Higher priority if you are symptomatic but they will test asymptomatic persons.

What can you do to get more of life open sooner?
Do your part to reduce transmission of COVID-19 and keep our R at or below 1. That means:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine. 

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 

 

5/13/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

On 5/7/2020, Gov. Newsom issued criteria for counties that want to move farther and faster into Stage 2 of Reopening.

L.A. County DPH posted their Roadmap to Recovery PowerPoint. We have reviewed the first 4 of 7 Regional Variance Criteria that counties must meet in order to move quicker through Stage 2. Our comments about the readiness of L.A. County are in italics.

Regional Variance Criteria
Epidemiologic stability

  • No more than one case per 10,000 people in the last 14 days
    Based on the L.A. County population of 10.1 million, that’s 1,010 cases over 14 days or approximately 72 per day. As of the last two weeks, it takes L.A. County only 1.2 to 1.3 days to hit 1,010 cases.
  • No COVID deaths in the past 14 days
    L.A. County has had an average of 43 deaths per day as of the week of 5/6 to 5/12; even if increased testing means more mild cases detected, it seems unlikely that our deaths would fall to zero over a 14 day stretch if we are still “allowed” to have 72 new cases per day.

Testing capacity

  • Minimum daily testing of 1.5 per 1,000 residents
    L.A. County averaged 1 test per 1,000 residents per day for the week of 5/6 to 5/12 – that’s the highest rate of testing over the past 4 weeks.

Protection of Stage 1 essential workers

  • Ability to support employees when sick or exposed
    How easy will it be for health care professionals to get tested for free? Do those free diagnostic tests have a 30% false negative rate that we have heard anecdotally? Will support include a space to isolate when that employee has no way to safely isolate at home? Help with childcare or other home responsibilities if needed while isolated?
  • Availability of disinfectant supplies and personal protective equipment (PPE)
    Where does L.A. County stand with PPE? We sure can’t get any. Are the hospitals still operating under the CDC contingency strategies? CDC crisis strategies? Analysis suggests that  approximately 45% of infections come from exposure to infected people in their pre-symptomatic stage making it clear that you need effective PPE for all close contact of greater than 10 cumulative minutes.

Containment capacity

  • At least 15 contact tracers per 100,000 residents
    That’s 1,515 contact tracers for L.A. County. Speed is essential in isolating cases and quarantining contacts to reduce transmission.
  • Ability to temporarily house at least 15% of county residents experiencing homelessness
    L.A. County had 58,936 homeless persons in 2019. The 2020 numbers are not out until May/June. 15% of the 2019 count is 8,840 persons. We have no clue how many homeless persons L.A. County is currently able to temporarily house.

What do we do to keep moving forward?

Basic preventive measures are still the most important contribution each individual can make to reopening.

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantining.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

5/6/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Testing numbers and availability

  • As of 5/1/2020, California was averaging 25,000 tests per day. This met the state’s testing goal to start Stage 2 of reopening. Ultimately California has a goal of being at 60-80,000 tests per day.
  • 60,000 tests per day in California would be 153 tests per day per 100,000 persons which would meet the Harvard Global Health goal referenced in previous updates. For comparison, L.A. County is 69 tests per day per 100,000 persons for L.A. County on average for the past week.
  • For the past week, L.A. County has extended free COVID-19 diagnostic testing to persons without symptoms. Go to https://corona-virus.la/ to sign up for a test. They still prioritize people with symptoms, increased risk of severe disease and people with increased risk of exposure but they will do testing without these factors.

Which symptoms to prompt you to think of COVID-19?

  • It really depends on who you ask. The CDC lists fever, cough, difficulty breathing, chills or shaking chills, muscle pain, headache, sore throat and new loss of taste or smell. This same list appears on the free testing website for L.A. County mentioned above.
  • LAC DPH has expanded their list from fever, cough and difficulty breathing to more closely mirror the CDC list.
  • The Pasadena Public Health Department’s list of symptoms to consider when reporting to work in an essential business also includes sneezing, runny nose, stomach cramps, diarrhea and not feeling well.

How long does virus remain detectable after COVID-19 and can it still infect others?

Test kits are still a precious resource. The end of isolation is usually determined by the  time-since-onset-of-symptoms method. The recently revised guidelines of 10 days since the onset of symptoms and 3 days after the resolution of fever and improvement of other symptoms is supported by research that shows virus that is able to copy itself has not been successfully cultured more than 9 days after onset of symptoms. A virus has to be able to copy itself to infect new people. Some people continue to test positive for virus for weeks to months after their illness, but we currently think they cannot infect others.

What do we do now?
Basic preventive measures will continue to be important indefinitely.

  • Wash your hands, avoid touching your eyes, nose and mouth, cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently
  • Maintain social distancing
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise
  • If you have symptoms suggestive of or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding isolation and testing

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 

4/29/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Testing
Evaluating adequacy of local testing capacity

  • Based on currently available information, L.A. County has averaged 30-70 diagnostic tests per 100,000 people per day over the last 5 days, better than before but still short of the Harvard Global Health goal of 150 discussed last week.
    https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html?referringSource=articleShare
  • Newsom announced on 4/22/2020 that 100,000 test swabs would arrive in California that week and another 250,000 the next week. For perspective, 100,000 swabs would last about 6.5 days if they were all used in L.A. County at a rate of 150 tests per 100,000 persons per day.
  • The percentage of positive tests in L.A. County is still running high, 13-15% (from daily press releases at http://www.ph.lacounty.gov), compared to the World Health Organization recommendation of <10%.
  • The curve of new cases in L.A. County is flattening but it is far from dropping – the new cases per day ranged from 440 to 1081 over the last 5 days.

Immunity
A few words on “herd immunity” (aka “community immunity”) https://www.cdc.gov/vaccines/terms/glossary.html#commimmunity

  • Herd immunity doesn’t mean that someone who lacks immunity to a disease can’t get sick, it only means that their risk of getting sick is lower when more members of their “herd” are already immune, either by virtue of having had the disease and having immunity that lasts or by virtue of an effective vaccine.
  • The more people who are already immune, the less chance that the disease will continue to spread because it has more trouble finding the next person to infect – this is especially important to people in the “herd” who are either especially likely to do poorly with the disease they are trying to avoid and those unable to be vaccinated because of medical issues when a vaccine becomes available.
  • Every little bit of reduction in transmission helps but for comparison, we already know that for Measles we need vaccination rates (as a proxy for immunity since we don’t routinely test these antibodies) above 95% to prevent outbreaks of Measles from sporadic imported cases.
  • As horrifying as the sheer numbers are for people infected with and dying from COVID-19, even when we are done with this first wave there will likely be less than 5-10% of the U.S. population will appear to be immune and only time will tell us if that immunity will last.

Other Information

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

4/22/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Another look at what it will take to move from Stay-at-Home to Reopening
Governor Newsom has pledged that decisions for California will be guided by health outcomes and science and has identified six key indicators that will be considered before modifying the state’s stay-at-home order.
https://www.gov.ca.gov/2020/04/14/governor-newsom-outlines-six-critical-indicators-the-state-will-consider-before-modifying-the-stay-at-home-order-and-other-covid-19-interventions/

Here are some thoughts we have on what these indicators look like for LA:
Cases:
A sustained reduction in new cases for at least 14 days would go a long way to protecting our community

Testing and Surveillance:

  1. Increased diagnostic testing will be key to monitoring and protecting our community
    •  Enough to test everyone with symptoms, do surveillance testing of frontline  
        healthcare workers, do testing of contacts of new cases, and to do some
        surveillance testing in the population at large – The L.A. Times online reported on
        4/21/2020 that California has approved testing for asymptomatic persons
        working in prisons and nursing homes and in some high risk households.
    •  Harvard Global Health Institute suggests a minimum of 150 test per 100,000
        people per day – California as a state was at 35 per 100,000 people on the day
        of 4/15/2020; LA County has been doing 15 to 45 tests per 100,000 people per
        day over the past week.
    •  When the portion of positive tests in a day of testing is greater than 10% of the
        total, the message is that you need more testing – the daily testing in L.A.
        County has been running 11 to 15% positive each day over the last week.
        https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html?referringSource=articleShare
     
  2. Testing to identify people who may be immune to COVID-19
    •  Everything we said last week about the issues with antibody (aka serology)
        testing still applies.
    •  The Center for Health Security at Johns Hopkins University gives a simple
        description of the three general types of antibody testing being developed and
        twice a week they update their site with the companies that have completed the
        Emergency Use Authorization process with the FDA. All of these tests have
        limitations and it will take using them to assess their reliability and usefulness
        and they will have the same problems with scaling up to the numbers of tests
        that are needed that has been experienced with the diagnostic testing
        processes. 
        https://www.centerforhealthsecurity.org/resources/COVID-19/serology/Serology-based-tests-for-COVID-19.html
     

Public Resources:

  1. Adequately resourced Public Health agencies
    •  Just looking at the people needed to trace contacts of new cases, there are
        currently 2,200 people between the CDC and state and local health departments
        for this work.
    •  China hired and trained 9,000 contact tracers in Wuhan alone; an equivalent
        response in the U.S. would be 300,000 contact tracers according to Dr. Tom
        Frieden, a former director of the CDC.
    https://www.nytimes.com/2020/04/18/health/coronavirus-america-future.html?referringSource=articleShare
    •  Although Apple and Google are teaming up to develop and roll out their contact
        tracing application in the U.S., questions related to privacy, accuracy and public
        acceptance remain unclear.
     
  2. The ability to support continued physical distancing in public as stay-at-home relaxes
    In order to have adequate physical distancing when in-person classes resume we may need:
    •  continued increased on-line course offerings compared to pre-pandemic
        offerings to avoid crowding on campus.
    •  a blend of in-person and on-line attendance (synchronous and/or asynchronous)
        in courses with enrollment that exceeds the available room capacity when
        factoring in physical distancing.
    •  continued easy access to hand washing and sanitizer supplies.
    •  use of masks may continue to be needed for an extended period.
    •  continued adherence to stay-at-home with symptoms of even mild illness and
        consideration of temperature screening for entry to campus.
    •  continued physical distancing in dining, athletic, and recreational areas.
     
  3. Hospital capacity and equipment to safely treat people sick with COVID-19
    •  Thanks to some combination of luck, density, and social distancing, our hospital
        capacity has not been exceeded; if we are not cautious, we can lose that
        advantage.
    •  Personal protective equipment is still insufficient; if we had enough, Newsom
        would not be making a billion dollar deal for more from China; you have seen the
        same stories we have of health care workers being threatened with firing for
        speaking out about lack of personal protective equipment.
     

These and other measures will be needed to dampen surges of infection and to protect the many in our college community who will continue to be at increased risk of severe disease while we wait for effective treatment and vaccine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

4/15/2020 Coronavirus Update 

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Some Good News to Start

  • It promises that decisions will be guided by health outcomes and science.

Another way to look at the numbers

The antibody tests are coming…BUYER BEWARE!

After being criticized for being slow in approving diagnostic tests for COVID-19 (the “are you infected now” tests), the FDA has given states permission to implement and manage their own antibody testing, AKA serology testing (“are you immune” tests) without FDA input. In an FDA statement made on 4/7/2020 statement, they note that 70+ test developers have already notified the FDA that they have antibody/serology tests available.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-tests

Some things to keep in mind:

  • Even once we start having results from antibody/serology tests, we won’t know the level of antibodies needed to protect us from re-infection or how long that protection will last until we can do surveillance testing (periodic “are-you-infected” testing) on people with antibodies, especially when individuals return to work and social events. We can hope to get some useful information from the countries that are ahead of us in this process.
  • Cellex is the only company that has gone through the EUA (emergency use authorization) process with the FDA for a clinical laboratory rapid test (not a home test.)
  • For now, if you see an ad offering to sell you a serology/antibody test at home, you should ask a lot of questions; no company has an “FDA approved” test (the Cellex EUA is not the same as “FDA approved”) and there could be a lot of companies coming after your money.

Apple and Google want to help

What are we supposed to do now? THE VERY SAME THINGS WE HAVE BEEN DOING SO FAR!

  • Wash your hands, cover your coughs and sneezes, wear a mask when you go out to grocery shop or might pass near other people, and don’t touch your face.
  • Stay more than 6 feet away from anyone who doesn’t live in your home
  • Isolate yourself if you are ill.
    http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

A parting thought….

This came to us attached to an email from a colleague. Like that colleague, we wish we could tell you the author’s name but it is still worth reading:

When you go out and see the empty streets, the empty stadiums, the empty train platforms, don't say to yourself, "It looks like the end of the world." What you're seeing is love in action. What you're seeing, in that negative space, is how much we do care for each other, for our grandparents, for the immuno-compromised brothers and sisters, for people we will never meet. People will lose jobs over this. Some will lose their businesses. And some will lose their lives. All the more reason to take a moment, when you're out on your walk, or on your way to the store, or just watching the news, to look into the emptiness and marvel at all of that love. Let it fill and sustain you. It isn't the end of the world. It is the most remarkable act of global solidarity we may ever witness.

Resources with Updated Information


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

4/8/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

KEEP IT GOING: DON’T LET UP YET ON SOCIAL DISTANCING

The Good…The Bad… And Keep Staying at Home  

  • New cases in L.A. County were dropping from a high of 711 new cases on Saturday 4/4, 663 new cases on Sunday 4/5 to 420 new cases on Monday 4/6. New cases on Tuesday 4/7 went back up to 550. Only time will tell us when we resume a downward trend. Everyone needs to do their part by following the "Safer at Home" recommendations by Mayor Garcetti.
  • Free testing is becoming more available in L.A. County. It is still focused on symptomatic people but without age and/or underlying conditions restrictions.

⇒See https://www.latimes.com/california/story/2020-04-06/all-l-a-residents-can-now-get-coronavirus-tests-as-restrictions-are-lifted-garcetti-says for more information
⇒Go to https://corona-virus.la/ to apply for testing at one of the 13 L.A. County sites 
⇒Although access to testing has improved, they can’t test everybody at once; there is still a priority on who gets tested first

For friends and family who think COVID-19 isn’t in their area
Disease modelers at University Texas Austin have found that:

  • Counties with even a single confirmed case of COVID-19 have a better than 50% chance of already having sustained, undetected transmission.
  • That probability rises to 95% with 10 confirmed cases.

You can read a summary of their study (Inside this summary you can follow the link to the actual study which is very interesting):
https://www.nytimes.com/interactive/2020/04/03/us/coronavirus-county-epidemics.html?referringSource=articleShare

How do we get out of where we are?
To do it safely we will need AT LEAST:

  • Even better availability of testing than currently exists:
    https://www.theatlantic.com/ideas/archive/2020/03/we-need-1-million-tests-week/609154/
  • A sustained reduction in new cases for at least 14 days (even as increased testing identifies more cases)
  • Adequately resourced and supported Public Health agencies with surveillance as well as symptom driven testing to find new cases and staff to follow those cases and trace contacts
  • Healthcare resources that are no longer stretched to the limit and imperiled by lack of protective gear so that the people who do get critically ill have the best chance to recover
  • Reliable testing to identify who may already be immune (not available yet in the U.S.) – those are the first people for whom to consider reducing restrictions

A lot of the above comes from https://www.nytimes.com/2020/04/06/upshot/coronavirus-four-benchmarks-reopening.html. Another interesting read is https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56.

Still your best protection

  • Stay at home – don’t even go out for groceries unless your cupboard is truly bare, and the next food delivery option is too far away – it’s time to eat up the things we have been passing over!
  • The key steps are still:

1.  If you are ill, start with the assumption that you have COVID-19 and isolate    
     with these instructions  
     http://publichealth.lacounty.gov/acd/docs/HomeisolationenCoV.pdf
2.  Wash your hands,
3.  Don’t touch your face,
4.  Wear a cloth mask if you must go out,
5.  Don’t touch the outside of your mask,
6.  Wash your hands again when you take a mask off.

PCC Helpful Resources

Resources with Updated Information


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

4/1/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

DON’T STOP HANDWASHING AND SOCIAL DISTANCING,
THEY ARE STILL THE MOST POWERFUL TOOLS WE HAVE

Keeping those numbers in perspective

  • According to the World Health Organization (WHO), on 3/31/2020, the U.S. leads the world in confirmed cases with 140,640. The number of cases is ahead of Italy at 101,739, Spain at 85,195 and China at 82,545.
  • If you look at cases per 10K of the 2019 population, the U.S. currently has 4.27 cases/10K (compared to Italy at 16.8/10K and Spain at 20.93/10K).
  • Our numbers will get worse before they get better but keep doing that social distancing thing to keep the numbers as low as possible.
     

Where are those plentiful and easy to get tests that we needed 6-8 weeks ago?

Time for some good news - early indications that social distancing is helping in California

Who should we assume has COVID-19?

  • About a week ago, the L.A. County changed how it views respiratory illness and states that ambulatory patients with symptoms of a viral respiratory illness should be presumed to have COVID-19. If we each start from the perspective of thinking we have COVID-19 and focus on what to do to avoid sharing it, maybe that will help. Safety first, protect others by protecting yourself--that's the take home message.
     

What can we do besides wash our hands and stay away from each other?
After no public comment since a 3/9/2020 media briefing, Dr. Robert Redfield, CDC director,  gave an interview on 3/31/2020:https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us?referringSource=articleShare
     The take home messages from this interview include:

  • As many as 25% of infected persons may remain asymptomatic – we don’t know who these people are and we don’t know if and how much virus they can share because we haven’t been able to do any surveillance testing
  • An infected person’s ability to share the virus probably starts 48 hours before the onset of symptoms in that person
  • When we get through the first surge in hospitalizations and deaths that will occur in April and May, 95% of Americans will still have no immunity to the virus
  • We can hope this virus behaves like influenza and that transmission decreases as weather warms, but we should expect to see it back by early winter
  • Any talk of letting up on social distancing will have to be focused on geographic areas where we have enough data on community transmission. That will necessitate surveillance testing which we are not currently able to do.

Dr. Redfield was asked if the CDC was looking at changing its mask recommendations. He was only willing to say that it is being “aggressively reviewed”. Until the CDC gets finished with its aggressive review, Student Health Services recommend that everyone should wear a mask when out in public.

If you live with someone who is at risk for severe illness with COVID-19, maybe you should look at the L.A. County self-isolation/quarantine PDF files in previous updates and consider what you want to do to reduce the risk of exposing your loved one in case you have asymptomatic infection.

Mask Information:

Is there something more you can do?

Calling all nursing students, RN, LVN, and CNA, who thought in January that they would be graduating soon. California wants you and will pay you to work. The anticipated time of need is now to June 30th. It is possible this work could be counted as clinical training missed under stay-at-home orders keeping nursing students on track for graduation. The call includes all healthcare providers, behavioral health professionals and health care administrators. The website is:https://covid19.ca.gov/healthcorps/

There is more information in Governor Newsom’s briefing on 3/30/2020:
https://sacramento.cbslocal.com/video/4497336-governor-newsoms-daily-press-conference-3-30-20-announces-establishment-of-california-health-corps/

And now, the care and feeding of the right side of the brain (videos and comics for your enjoyment):

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

3/25/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

SYMPTOMS TO CONSIDER

WONDERING IF YOU NEED A COVID-19 TEST

  • The “Situation” section of the 3/25/2020 health alert by the Los Angeles health Alert Network (LAHAN) provides some guidance: http://publichealth.lacounty.gov/eprp/lahan/alerts/LAHANCOVID032520.pdf
  • ⇒ DO NOT test symptomatic patients that can be managed at home with these instructions: http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf
    • If you can safely self-isolate, that is what you should do.
     
    ⇒DO NOT test asymptomatic people, EVEN IF THEY MAY HAVE BEEN EXPOSED. L.A. County and San Bernardino County DPH define “exposed” as persons with close contact of a known/suspected case of COVID-19 (within 6 feet for more than 10 minutes) or having handled bodily fluids of that person without appropriate protective gear starting on the first day that the known/suspected case was symptomatic and extending until that case has been released from isolation. People who know they have been exposed by those criteria should be told to self-quarantine following the home quarantine instructions: http://publichealth.lacounty.gov/acd/docs/COVHomeQuarantine.pdf

HOW LONG TO ISOLATE COVID-19 CASES AND PEOPLE IN CONTACT WITH THEM?

NEW TESTING RESOURCES FOR THE CITY OF LOS ANGELES

  • The City of L.A. is offering COVID-19 testing to city residents who meet one of three criteria for testing. They hope to extend testing to L.A. County residents in the near future. To see their current criteria for testing and apply for a test, go to: https://lacovidprod.service-now.com/rrs  

EFFECTIVE CLEANING AGENTS
For proper disinfection of SARS-COV-2, the virus that causes COVID-19:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

  • The EPA “N list” has the products considered effective
  • They are listed in ascending numerical order of their EPA registration numbers, the first two sections of which describe the active ingredients
  • If the product you are using has the same first two sections as a product on the N list, then your product is also effective
  • The N list also tells you how long the item needs to stay wet (wet contact time) with each cleaning product

CLEANING ADVICE

REMEMBER: PREVENTIVE MEASURES ARE STILL OUR STRONGEST TOOLS

  • Stay 6 feet away from others; learn to love virtual socializing
  • Wash or sanitize your hands frequently
  • Avoid touching your eyes, mouth and nose
  • Cover your coughs and sneezes 
  • Stay away from other people when you are ill
  • Clean your work areas with an EPA approved cleaning product
  • Consider using gloves when working outside of the environment you can clean. It might at least remind you not to touch your face

STUDENT HEALTH SERVICES and PERSONAL COUNSELING SERVICES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

3/18/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES
The trend in numbers of COVID-19 cases continues to change on a daily basis. Please refer to the links in the Resources section listed below for the current numbers of cases.

PREVENTION
The most impactful means of reducing transmissions of COVID-19 are the basic preventive measures (social distancing, groups less than 10, handwashing, isolate when ill, etc.) Paying attention to these measures can allow us to slow down the spread of disease in hopes of keeping medical care needs within the bounds of available medical human and equipment resources. Persons at increased risk of poor outcome with COVID-19 by virtue of age and/or underlying illness should be especially vigilant.

REMOTE ASSISTANCE TO STUDENTS
Though campus is closed to students and the public, Student Health Services will continue to address medical concerns of students. Students with medical questions are asked to contact SHS by email at:

medicalSHS@pasadena.edu

They should include their full name, lancer number, enrollment status, their question and a phone number where we can reach them, if needed. We intend to reply within 24-48 hours during our usual working hours of 8:00a-4:30p Monday-Thursday and 8:00a-12:30p Friday except for weekends and holidays.

FACULTY/STAFF
Faculty and staff are encouraged to take their medical questions to their medical providers. The SHS web site includes a list of low cost medical services in the area: https://pasadena.edu/campus-life/student-health-services/community-referrals.php

TESTING
Testing for COVID-19 is still a limited resource at this time and requires that a medical provider determine that either you meet your local Public Health Department criteria for free testing or that you have insurance or other resources to cover the cost of testing. There are several avenues through which we hope testing will expand in the near future. We will provide updates as it becomes available.

The California Department of Public Health has launched a new website which covers all the basic preventive measures as well as information about state case numbers, testing, unemployment, family leave and disability benefits: https://covid19.ca.gov/

RESOURCES

⇒ Home Isolation Instruction: 

http://publichealth.lacounty.gov/acd/docs/HomeisolationenCoV031520.pdf

⇒ Home Care Instructions for Mild Respiratory Illness:

http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

⇒ Travel Notices:

https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html#travel-1

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

3/12/2020 Campus Update: Classes Cancelled Monday 3/16 and Tuesday 3/17

As PCC continues to take additional steps in response to the coronavirus outbreak, I am writing to let you know of two important updates:

  • In consultation with the Academic Senate and the Faculty Association, Dr. Endrijonas has decided to cancel all face-to-face classes on Monday and Tuesday, March 16 and 17, so that faculty, deans, and classified staff can continue the important work of implementing our transition to remote instruction. All administrative and business functions will continue as normal – the college is open for business. Courses and support services will begin moving online as soon as they are ready. It is our expectation that every possible course will meet through remote methods beginning Wednesday, March 18. For more information, contact your instructor.
  • Following a decision by the California Community College Athletic Association, all spring sports games and practices are suspended indefinitely.

Additional information you may find helpful in the days and weeks to come:

  • This morning Dr. Endrijonas held a video briefing for college faculty and staff. You can view the video here.

    In her remarks, Dr. Endrijonas summarized the recent actions the college has taken to address the coronavirus pandemic. These include moving all possible courses to remote instruction during the period of March 18 to April 20; cancelling or postponing all college and community events during that same time period; and curtailing all district-sponsored travel through April 30. We also provided information on how Student Health Services is assisting students, how Facilities Services is cleaning and sanitizing our physical plant regularly; and how you can stay in touch with the college and let your concerns and questions be known.
  • Counseling Resources for Students: Counselors are accepting virtual appointments through this link. Counselors can help you understand your options during this transition and also update your educational plan.
  • PCC Personal Counseling and Social Services: Students who may be in need of support or resources should visit these offices to learn more. There is a referral guide produced by Personal Counseling that will be of assistance and Social Services information is available online.
  • Q&As: Please keep your questions and comments coming! We are continually updating our FAQ page and tomorrow we will be updating our Health Updates page so you can more easily find important information quickly.

Thank you for your continued engagement. We are reading your messages and making an effort to respond wherever possible. Your feedback helps us know what our community is facing during this challenging time.

Thank you for your patience and understanding as we navigate this emergency.

3/11/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES
As of 3/11/2020:

  • 27 confirmed cases in L.A. County

  • The college has no indication that the individual who has tested positive for coronavirus in Pasadena has interacted with people or facilities at the college. We are working with public health authorities to monitor and respond to the situation.

  • We will continue weekly updates as well as emergent briefings as needed.

  • With increasing numbers of cases in the U.S., the CDC has transferred responsibility for setting criteria for COVID-19 testing to state and local Public Health Departments. Pasadena Public Health Department is using the L.A. County Department of Public Health clinical criteria for testing.  

WHAT YOU SHOULD STILL BE DOING NOW

  • Continue basic preventive measures – Wash your hands; avoid touching your face; cover your coughs/sneezes; stay away from sick people; replace handshakes and hugs with elbow bumps or verbal greetings; get the flu shot if you have not earlier this flu season.

These basic preventive measures are our best tools for slowing the spread of this virus. Slowing the spread of the virus makes it more likely that medical resources will be sufficient to meet the medical needs of the people who need help.

  •  Stay home if you are sick

1. If you are sick, have a fever ≥100°F (≥37.8°C), or have a spewing productive cough that is difficult to contain, stay home and away from other people until your temperature has been below 100°F for 24 hours without having to use fever reducing meds to get it there and you can manage your cough/other symptoms.

2. The faculty has been asked to adjust their absentee/missed work approaches to better accommodate students who should stay home because they are ill.

3. L.A. County DPH has some advice for people who need to stay home for mild illness and are not felt to need testing for COVID-19: http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

  • Identify your medical provider and how to contact them – When we start to have community transmission locally, telephone consultation will help protect you and others.

  • Update your Emergency/Earthquake plan – Have enough of the medications you usually take and fever reducing medications if you can use them; food for people and pets, toilet paper, feminine products, kitty litter, basic first aid supplies including a thermometer, cleaning supplies and a communication plan with your family. CDC has some preparation advice for home, school, and work: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html?deliveryName=USCDC_2067-DM21103 

ADDITIONAL INFORMATION

  • If you or someone in your family is identified as a COVID-19 case and well enough to be managed at home, you will be given self-isolation instructions by Public Health. http://publichealth.lacounty.gov/acd/docs/COVHomeIsolation.pdf (also available in Chinese).

  • If there is sufficient local transmission, Public Health, in consultation with school administration could advise closing the school. PCC has an Airborne Transmissible Disease (ATD) Plan that is being updated on an ongoing basis for the current situation. You can see this document at https://pasadena.edu/campus-life/student-health-services/latest-health-updates.php. If you have questions for which you cannot find answers among the updates clicking on “send us your feedback” takes you to a form to submit questions by email.

RESOURCES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

3/10/2020 – Coronavirus Response: Update 

The following message was sent to faculty and staff:

March 10, 2020

Sent on behalf of Superintendent/President Erika Endrijonas

Dear colleagues:

In order to limit the transmission of coronavirus (COVID-19) on campus, and in an abundance of caution for the health and safety of our students, faculty, and staff, I am writing to let you know of specific actions the college will be taking over the coming days and weeks. Please note that there are no confirmed cases of coronavirus on our campus at this time, and the college is not closed for business.

The changes listed below will be in effect from Wednesday, March 18, through the end of Spring Break, April 20. Any change to this timeline will be made at a later date, in response to information gained from public health officials.

  • By March 18, PCC will convert most in-person classes to offer temporary remote instruction wherever possible through Canvas, Zoom, and other modalities. No changes will be made to courses that require face-to-face instruction; these courses will continue to meet on campus as scheduled. Examples of courses in this category include performing arts, lab courses, and physical education. Faculty should contact their dean for further clarification.
  • From March 18 through April 20, college events with a projected attendance of more than 100 people will be cancelled or postponed. Sporting events will be conducted wherever possible without spectators, while college arts performances will be postponed until later in the semester. Community events will be cancelled or postponed.
  • To help facilitate this transition, the agenda for PD Day will be reconfigured to allow faculty, staff, and managers time to prepare for these changes. Breakfast and lunch on Thursday (March 12) will proceed as planned in the Piazza, as will the streamed message from Dr. Endrijonas at 9 a.m. sharp. Faculty, staff, and administrators should plan to tune in to the stream to learn more about our ongoing response to the coronavirus outbreak. The special classified morning event and all afternoon breakout sessions have been cancelled. More information about how preparations will unfold within Academic divisions and student services and other departments will be forthcoming from the Office of Professional Development and your supervisor or dean.
  • The college is not closing. College facilities will remain open, and many operations will continue normally. Unless they are actively sick, employees should report to work as normal. Facilities Services has been increasing cleaning and sanitization efforts, and increased supplies of hand sanitizer, soap, and other cleaning products are being distributed. More information will be provided through your supervisor or dean as it becomes available.

A separate email with this information has been sent to students. 

These changes may cause some stress and uncertainty. If you notice someone who has been impacted by this emergency, please remind them that help is available. One option is PCC’s Employee Assistance Program, which provides confidential, complimentary counseling and other assistance to employees and their dependents. Please contact Human Resources if you need additional guidance with this resource.

This emergency will continue to have impacts, and we will continue to respond accordingly. Throughout this emergency, we have been balancing our educational mission with our imperative to protect the health and safety of our students, faculty, and staff. As more information about this outbreak has become evident, these actions represent prudent steps we can take to respond effectively to a rapidly changing situation. We appreciate your flexibility, commitment, and professionalism as we navigate this challenging time together.

3/5/2020 Pasadena City College and the Coronavirus outbreak

Posted by Pasadena City CollegeAs you may have seen, yesterday the LA County Department of Public Health announced that there are additional confirmed cases of the Novel Coronavirus in Los Angeles County. As a precautionary measure, both the county and the city of Pasadena declared a public health emergency in their jurisdictions. It is important to note that there are no confirmed cases of coronavirus transmission in Pasadena at this time, and PCC is open for normal operations.

Current events may cause surprise and worry, so I want to share information about what Pasadena City College is doing to keep our community healthy and safe. There are a number of things we can all do to help reduce the likelihood of this illness impacting our lives, and to also help public health authorities effectively manage this outbreak.

What can I do?

  • Practice good hygiene: 
    • Wash your hands frequently
    • Avoid touching your eyes, nose and mouth
    • Cover your coughs and sneezes, and then wash your hands again
    • Stay at least 6 feet away from sick people
    • Replace handshakes with elbow bumps or verbal greetings
    • Get the flu shot if you haven’t in order to reduce the number of opportunities to become ill.
  • Stay home if you are sick:
    • If you have a fever of 100°F or greater, along with a cough, sore throat, or shortness of breath, it is important that you stay home and away from other people. Once your temperature has been below 100°F for 24 hours without medication, and your other symptoms are not causing problems, you should return to the college.

      We understand that staying home can present challenges to work, home, and daily life. The college is prepared to accommodate reasonable absences in light of this public health crisis. If you have any concerns, please direct them to your supervisor or area vice president and they will work to find a solution.
  • Identify your medical provider and know how to contact them:
    • Our medical system is expected to be under high demand during this time. While you should only contact your medical provider if its services are needed, now is a good time to know what numbers to call so you’re prepared in the future.
  • Help the college maintain order and remain calm:
    • As with any emergency, new details are emerging every day and it’s difficult to know what is fact and what is rumor. While it is totally normal to have fears and worries during this time, it’s important to remember that we speak from authority when interacting with other members of our community – particularly students. If you know of someone who is experiencing severe stress during this emergency, it may be helpful to share the simple steps and facts contained in this message. If you are asked a question and you don’t know the answer, please refer to statements by public health officials or law enforcement agencies, rather than repeat what might be trending on social media. Some helpful websites include:

What is PCC doing?

Beyond these individual actions, the college is taking steps to respond to this emergency. PCC staff are in regular contact with local law enforcement and public health officials, and we are constantly evaluating our operations to see if any changes are necessary. Custodial staff are installing and updating handwashing, sanitization, and cleansing wipe stations around our campuses. Faculty and administrators are exploring alternative methods of coursework – including online and remote classes – so that classes can continue if in-person attendance is problematic. This information is being communicated to deans and faculty as soon as it becomes available. The college has a response plan and is using it to address developing events. Remember, courses and public events are still ongoing, and the college will only limit its activities if it is absolutely necessary. 

How can I stay informed?

During any emergency, it’s important to know how to find trusted information. There are a couple of key ways you can stay informed as this outbreak continues to develop:

If you have a question or concern that you would like to share, please send it to us and we’ll be able to help.

3/4/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES

  •  As of 8:30am 3/4/2020, by the announcement made by the L.A. County Board of Supervisors and the L.A. County Department of Public Health, there are 6 new COVID-19 cases confirmed in L.A. County in the last 48 hours. Each of these cases has a known presumed source of illness so there is still

No evidence of community transmission yet

daily update radio briefings

ph.lacounty.gov

  • We will continue weekly updates as well as emergent briefings as needed.

  • L.A. County Board of Supervisors and the L.A. County Department of Public Health are declaring a Local Health Emergency to enhance coordination and implementation of activities to protect the public. Pasadena Public Health and Long Beach Public Health expect to do the same (no confirmed cases in those two areas). There are no closures or changes to public events at this time.

  • If you want to see the CDC numbers for the U.S. (that are now being updated each week day): https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

  • CDC guidelines for who to test continues to evolve: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. The decision to test is made by the Public Health Department for the geographic area of the candidate for testing.

WHAT YOU SHOULD BE DOING NOW

  • Continue basic preventive measures – you know the drill! Wash your hands, avoid touching your eyes, nose and mouth; cover your coughs and sneezes; wash your hands again if you used a tissue to do that last one; stay 6 feet or more away from sick people; replace handshakes with elbow bumps or verbal greetings; get the flu shot if you haven’t in order to reduce the number of opportunities to become ill.

  • Stay home if you are sick – fever ≥100°F (≥37.8°C) or a spewing productive cough that is difficult to contain are two of several good reasons to stay home and away from other people until your temperature has been below 100°F for 24 hours without having to use fever reducing meds to get it there and you can manage your cough/other symptoms.

  • Identify your medical provider and how to contact them – when we start to have community transmission locally, telephone consultation will help protect you and others

  • Update your Emergency/Earthquake plan – (you DO have one, right?) Thankfully we probably WON’T lose power, water and communication channels but a lot of the other issues are the same; have enough of the medications you usually take and fever reducing medications if you can use them; have enough shelf/freezer stable food for people and pets, toilet paper, feminine products, kitty litter, basic first aid supplies including a thermometer, cleaning supplies and a communication plan with your family. CDC has some preparation advice for home, school, and work: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html?deliveryName=USCDC_2067-DM21103

ADDITIONAL INFORMATION

  • If you or someone in your family is identified as a COVID-19 case and well enough to be managed at home, you will be given self-isolation instructions by Public Health. Here is what L.A. County Public Health Department says: http://publichealth.lacounty.gov/acd/docs/HomeCarenCoV.pdf (also available in Chinese).

  • If there is sufficient local transmission, Public Health, in consultation with school administration could advise closing the school. PCC has a Pandemic Preparedness Plan that is being updated for the current situation and will be distributed to the appropriate individuals who will assist with enforcing the plan, if needed.

RESOURCES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

2/26/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

Cases:

  • U.S. cases reported by the CDC as of 4 pm 2/25/2020:

                12           travel related
                  2           household contacts or travel related cases
                  3           repatriated from Wuhan, tested by CDC
                42           repatriated from the Diamond Princess, tested by CDC
               59         TOTAL CASES

  •  Still no new cases in L.A. County 

Travel:
CDC provides travel advice regarding COVID-19 at https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html As of 2/25/2020, CDC recommends the following (refer to the above CDC link for detailed descriptions related to each of the following categories):

  • Avoid all nonessential travel based on widespread community transmission in:

o   China
o   South Korea

  • Practice enhanced precautions based on sustained community transmission in:

o   Iran
o   Italy
o   Japan

  • Practice usual precautions based on multiple instances of community transmission in:

o   Hong Kong

  • Other destinations with risk of community spread:

o   Singapore
o   Taiwan
o   Thailand
o   Vietnam

Keeping Your Work Area Clean:
Surface cleaning solutions that are Environmental Protection Agency (EPA) registered for use in hospital and healthcare settings are effective for killing the virus responsible for COVID-19.  You must achieve the wet contact time--letting the surface dry on its own, after cleaning with the product. This could be 2 to 10 minutes or more depending on the product. Check each product for specific recommendations.

Protection:
AS A REMINDER: Your best protection is still

  • Frequent hand washing
  • Avoid touching your eyes, nose and mouth
  • Stay >6 feet away from people who are sick
  • Stay home when you have a fever until your temperature is under 100°F/38°C for 24 hours without the use of fever-reducing medicines
  • If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with your sleeve, scarf, or clothing items (e.g. T-Shirt)
  • Get the 2019-20 seasonal flu shot while limited free doses are still available for students at Student Health Services

2/19/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

  •  As of 2/19/2020, the CDC is still reporting 15 identified cases in the U.S. This number does not include persons being brought back to the U.S. for treatment/quarantine from the Diamond Princess Cruise ship.
  •  There continue to be no new cases in California and in L.A. County.
  •  If you are an asymptomatic traveler who returned to the U.S. on or after 2/3/2020 and who had traveled in China within the 14 days before your return to the U.S., please review the recommendations posted on the 2/12/2020 update.
  •  REMEMBER: Your best protection is still

o   Frequent handwashing
o   Avoid touching your eyes, nose and mouth
o   Stay >6 feet away from people who are sick
o   Stay home when you have a fever until your temperature is under 100°F/38°C for
     24 hours without the use of fever-reducing medicines
o   If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with
     your sleeve, scarf, or clothing items (e.g. T-Shirt)
o   Get the 2019-20 seasonal flu shot; there are still some free doses for students at
     Student Health Services

Resources on COVID-19:

Pasadena Public Health: https://www.cityofpasadena.net/public-health/news-announcements/local-information-and-guidance-for-novel-coronavirus/

LA County Public Health: http://publichealth.lacounty.gov/media/Coronavirus/

CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html

2/12/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services. 

  • COVID-19 is now the name for the 2019 novel Coronavirus infection that started in Wuhan, China
  • As of 2/12/20 afternoon, there are 14 identified infections in the US with 8 of those being in California and still only one in LA County
  • The advice has changed for asymptomatic persons who:

1. have traveled in Hubei Province or elsewhere in mainland China in the past 14 days and
2. have arrived in the US on or after 2/3/20 and
3. have no other known risk factor for exposure to COVID-19 other than travel

Asymptomatic individuals meeting the guidelines in bullet point #3 above—who traveled in Hubei Province, should be actively monitored by their public health department on a daily basis with no public activities until symptom free for 14 days. Of note, day 1 is the day after departure from China. Please contact your local public health department for specific directions.

Pasadena Public Health: https://www.cityofpasadena.net/public-health/

Los Angeles County Public Health: http://publichealth.lacounty.gov/

Asymptomatic individuals meeting the guidelines in bullet point #3 above—who traveled elsewhere in mainland China, should do self-monitoring with supervision by their local public health department and avoid congregate settings (e.g. schools, concerts, etc.), limit public activities and practice social distancing until symptom free for 14 days (day 1 is the day after departure from China).

Transit through an airport in Hubei Province or mainland China without time outside the airport is generally not considered to be an exposure.

At this time, Hong Kong, Macau and Taiwan do not have widespread transmission of COVID-19 and are not considered part of mainland China for this guidance.

  • REMEMBER: Your best protection is still

o   Frequent handwashing
o   Avoid touching your eyes, nose and mouth
o   Stay >6 feet away from people who are sick
o   Stay home when you have a fever until your temperature is under 100°F/38°C for
     24 hours without the use of fever-reducing medicines
o   If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with
     your sleeve, scarf, or clothing items (e.g. T-Shirt)
o   Get the 2019-20 seasonal flu shot; there are still some free doses for students at
     Student Health Services

For additional information on the Coronavirus and other health news, please refer to the Student Health Services webpage: https://pasadena.edu/campus-life/student-health-services/latest-health-updates.php

Resources on COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Coronavirus+Colleges+Guidance+2_11_20.pdf

2/11/2020 Measles Update

There is a recent outbreak of measles sites mostly in West Los Angeles back in late January early February.

Suspected measles cases have:

  • Fever and Generalized Rash
  • Had exposure to measles within the last 3 weeks

 http://www.publichealth.lacounty.gov/hea/library/topics/measles/CDCP-IP-0012-01.pdf

2/7/2020 Update 

In response to a steady stream of questions relating to the Coronavirus outbreak, Student Health Services have developed the following Q&A. If you have questions contact Student Health Services. 

PCC Q&A on the Novel Coronavirus (nCoV)

Answers to frequently asked questions are below; additional helpful information is available at the Centers for Disease Control and Prevention (CDC) FAQ website https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Faculty’s instructions to students: Individuals with a fever greater than 100.4 °F or 38°C or who are unable to contain coughing or sneezing, should refrain from attending classes or work until their symptoms are controlled. Inform the student to go home. Faculty should work with the student to make up class work and instructions, rather than penalizing the student for missing class.

Students’ instructions: You should consult your primary doctor or contact Student Health Services (626-585-7244) if you are unwell.

Do not assume, on the basis of appearance, in the presence of flu-like symptoms that they have coronavirus. 

Patients with confirmed 2019-nCoV infection have reportedly had mild to severe respiratory illness with symptoms of:

    • fever (>100.4 °F or 38°C)
    • cough
    • shortness of breath

Many cases appear to be mild. Individuals who are elderly, have weakened immune systems, or have other underlying health conditions appear to be at risk for more severe disease.

Local public officials will conduct a “contact tracing” measure with identified patients and proactively contact any individuals who might have had an exposure. They will work with any individuals who may be affected to monitor if any symptoms develop.
Coronaviruses, including the 2019-nCoV, are considered airborne transmissible diseases.

The college is taking extended measures to ensure a hygienic environment, including regular cleaning of common areas, and refilling of soap and hand sanitizers. 

Flu and other serious respiratory illnesses are commonly spread by cough, sneezing, or unclean hands.

    • Covering your nose and mouth when coughing or sneezing prevents the spread of a virus.
    • Handwashing (with soap and water) for 20 seconds reduces risk of infection. (https://www.cdc.gov/handwashing/videos.html).
    • Avoid touching your eyes, nose, and mouth. Avoid close contact with someone who is sick. Please refer to the most recent email blasts on updates, distributed 2/5/2020.
Isolation and Quarantine are not currently recommended for asymptomatic individuals.
Anyone seeking evaluation based on symptoms plus travel/exposure in the last 14 days should make their first contact by phone (Public Health Department, Student Health Services, or Primary Care Provider) to limit the exposure of other people until a decision can be made over the phone about the need and location for testing. If testing is recommended, you should isolate yourself to avoid exposing others. Cover your mouth and nose with a mask, scarf or other fabric if you are told to leave self-isolation for testing.
In the event of a PCC student testing positive for the 2019-nCoV, the patient would receive appropriate medical attention and would be under monitoring of Public Health officials. The Public Health officials will determine which other persons should be evaluated as close contacts. 
It's hard knowing people you care about are in the middle of a very scary situation far away. We know that this has been a difficult time for many members of our college family. Please know we are here for you and encourage you to reach out for support. If you want to meet with a counselor, please call 626-585-7273.

You can also help your family back home by letting them know you are taking good care of yourself. The best advice for not getting sick is to practice frequent handwashing and staying out of close contact with people who might be sick. Let them know you are well, and it may comfort and reassure them. As opportunities to assist become available, we will share these with the community. 
No, the flu shot is formulated to match influenza viruses expected to be circulating in the United States during the 2019-2020 flu season (Los Angeles County is currently seeing a rising number of cases, so please get a flu shot if you have not already done so). The influenza virus is a different virus from the coronavirus. The coronavirus has many genetic variants, including the “common cold” that generally does not present serious adverse health risks.
Students coming to Student Health Services with fever, cough, or shortness of breath will be given a mask to wear. Cover your mouth and nose with a scarf or other fabric, if you do not have a mask.
Wearing face masks routinely is not recommended for people who are not sick. Masks help sick people reduce spread of illness to others but are not very effective protection for well people.
Remember that hand gel does not replace handwashing with soap and water; handwashing is a more effective way to reduce the spread of infection.