By Dr. Anthony Policastro

Instead of doing both an article and a COVID update this week, I am just going to spend some time updating COVID items.

Since July 7th, the number of new cases nationally has risen by between 56,000 and 79,000 every day.

That resulted in a doubling of new cases in 41 days. That compares to 45 days for the last doubling. Therefore, we are still being relatively consistent with the rate of spread.

There continue to be areas that are hot spots. However, when they settle down, there will be new ones somewhere else. It is important to remember that we are actually doing a better job of counting now because of the increased use of testing.

In 2018 the mortality statistics in the US looked like this:

Heart disease  – 647,000

Cancer             – 599,000

Accidents        – 169,000

Pneumonia     – 160,000

Stroke              – 146,000

At present (July 27th) COVID-19 deaths stand at 149,852. It will likely pass pneumonia and accidents in the next month or two. So for 2020 it will be our third biggest cause of death.

There are of course the naysayers who say that the mortality numbers are inflated. Some deaths are caused by other things in COVID infected patients. A heart problem in a patient treated with hydroxychloroquine is a good example. Some patients are already terminal (like those in hospice). Covid just speeds up the process.

The question is how much over counting is there. The CDC looked at this. They published their report on July 15th.

They looked at how many people died between February and June over the last few years. They came up with an expected total number of deaths for the year. They compared it to the total number of deaths that we actually have seen this year.

Their conclusion was that we had excess deaths this year. The excess number was somewhere between124,892 and 168,675. That means that the 149,852 number being reported for COVID deaths is pretty close to what has actually occurred in terms of excess deaths this year. Thus if there is any over counting, it is minimal.

Pharmaceutical companies continue to work on a vaccine for COVID-19. Vaccines that we currently use are of two types. The first is the kind that contains dead weakened (attenuated) organisms. MMR is an example of that. The second is the kind that contains dead organisms. The flu shot is an example of that.

Sinovac (a Beijing based company) is doing trials with an inactivated coronavirus in Brazil. It is called Coronavac. These trials take a long time. The virus has to be grown and then inactivated.

Coronavac is a much more traditional process. The testing so far was in 743 patients as of mid June with over 90% of them developing antibodies with minimal side effects. This is a very promising vaccine.

Another company tried using dead viruses in their vaccine. However only 57% of the test subjects developed antibodies. So that does not look like the right approach for this virus.

The other vaccines being created are using new genetic techniques. They are creating proteins in a laboratory. The proteins contain part of the COVID-19 RNA chain.

The idea is that if the body develops antibodies to part of the virus, it will succeed in killing it. We have not done this with a vaccine before. It has only been tried with a disease called dengue. However, dengue vaccine is not yet available so we don’t know if this technique works well.

The U.S. is so convinced that this new method will work that they announced on July 22nd, that they were ordering 100 million doses of the one that Pfizer is working on.

The cost would be almost $2 billion. What drove the decision was that if we waited, there might not be enough available.

Pfizer is about to enter Phase III trials. Up to this point, they have “proven” that the vaccine produces antibodies to the protein. They did that in a total of 45 patients. Of that group 24 patients received two doses. Another 12 patients received one dose. The remaining 9 patients received placebo.

The vaccine resulted in antibody production. The antibodies were against the protein not exactly against COVID-19. There were no significant side effects in the 36 people who had the vaccine. So because of those findings in 36 people we have ordered 100 million doses.

The next phase is due to be completed and reviewed in October. If the review is positive and permission is granted to distribute it, we will not see it until December or January.

My personal opinion is that with only 36 patients given the vaccine, it is kind of early to be committing to that vaccine.

Coronavac is likely to be the better vaccine in the long run. However, since it is a Chinese company, people might be reluctant to use it. That might be foolish in the long run.

I understand the concern about vaccine availability. However, having a vaccine that is available is not the only consideration. It must be safe. It must be effective.