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CMG COVID-19 Weekly Update 8.1.21

New or Updated This Week:
Good News, Bad News, and Worse News on the Delta Situation in the US (new)
Revised CDC Guidelines on Masking and Testing for the Fully Vaccinated (new)
Moderna/CMG Pediatric Vaccine Trial – Stage 2 (new)
Status of the Pandemic in the United States and the World (updated)
Status of the Pandemic in the Washington Area (updated)
Statistics – CMG Tests for Active Disease (updated)
Group Virtual Visit Offerings – Catalogue of This Week’s Sessions (updated)

Hello again everyone. This is the 69th in a series of COVID-19 updates from Capitol Medical Group. These notices are meant to provide an update on the pandemic, explain procedures we have put in place to best serve you, and provide guidance about protecting yourselves and your families. New and updated sections are so indicated.

In an effort to ensure that this notice reaches everyone in our practice, we are sending it to every patient on file rather than one per family. Our apologies if your family receives multiple copies.

Good News, Bad News, and Worse News on the Delta Situation in the US (new)

To the worst news first: the pandemic has intensified markedly in the United States over the last two weeks. The Delta variant has become predominant and is spreading rapidly. Though the current epicenter of the pandemic in the US is the Mississipi River valley and the Gulf Coast, 42 states experienced an increase in caseload of 100% or more over the last two weeks. 13 saw an increase of 200% or more. 122,000 new cases were identified Friday alone, the highest number since early February. Hospitalizations have increased dramatically. Daily deaths, a lagging indicator, have also started to increase (see below for details). Cases in Louisiana and Florida are now exceeding their winter peak, and hospitalizations in both states are approaching their winter peak.

Unfortunately, we expect the situation in the United States to worsen further in the coming weeks. The Delta-fueled waves in India and the UK took 6-8 weeks to crest. The US is roughly 3 weeks into its Delta wave and is in the midst of a heavy travel and visitation season which is likely to facilitate additional viral spread. This represents a major threat to adults who are unvaccinated or have poorly functioning immune systems. As you are aware, that threat is magnified for those who are older, have underlying medical conditions, or are overweight. If you are not yet vaccinated, we once again urge you to seek vaccination immediately.

Adding to the bad news, there is increasing evidence that those who encounter Delta after vaccination are more likely to develop mild to moderate symptoms than was the case with previous variants. These individuals also appear more able to transmit the virus than has been the case with other strains. It is not clear why this is the case, but it appears Delta is able to quickly generate a much higher viral load in those infected than other strains. It is possible that the rapid generation of viral particles creates a window of time during which some vaccinated individuals exhibit symptoms and become contagious before the immune system can quash the developing infection. This window, if it occurs, is sure to be much smaller than among the unvaccinated, who do not have immune systems already primed to attack the virus. The unvaccinated are far more likely to develop significant symptoms, spread the virus to others, and take longer to clear the infection.

A prominent real world example of viral uptake and transmission among the vaccinated is a case cluster that occurred in Massachusetts in July. Details of the cluster were published Friday in the CDC’s Morbidity and Mortality Weekly Report. The report details 469 cases stemming from a series of celebratory events at bars, restaurants, and houses in Provincetown in early July (there are now known to be over 900 cases associated with this cluster). Of the 469 cases, 346 (74%) occurred among people who had been fully vaccinated. Of these, 79% became symptomatic to some degree. 4 of the 346 vaccinated individuals (1.2%) required hospitalization. None died.

And this leads to the good news: though the vaccines seem to be somewhat less able to prevent symptomatic disease caused by Delta, they remain extremely protective against severe disease and death. Data presented at an internal CDC meeting this week indicate that there are currently 0.96 Covid-related deaths per 100,000 unvaccinated individuals per week in the US. Among the vaccinated, the number is 24 times lower: 0.04 deaths per 100,000 individuals per week. Similarly, there are currently 2.52 hospitalizations per 100,000 unvaccinated individuals per week, but just 0.1 hospitalization per 100,000 vaccinated individuals per week. These numbers indicate that there is a roughly 25-fold reduction in risk of hospitalization and death among the vaccinated as compared to the unvaccinated. This is what the vaccines are primarily meant to do – prevent severe illness and death.

 

There are two other pieces of potentially good news this week. The first is that the Delta surge in the UK has passed its peak and is now declining rapidly. This has been a characteristic of Delta waves in several countries – an exponential increase in caseload followed by an exponential decrease once the wave crests. As referenced above, both India and the UK took roughly 6-8 weeks to reach their Delta crests, but both then experienced a sharp drop. Though there is certain to be a great deal of suffering and death in the United States over the next month or more, there is at least some hope that once this wave crests the caseload may drop precipitously.

There is also a chance – albeit a tenuous chance – that this is the last major wave that will cause a significant increase in Covid-related mortality in the United States. Between those who are vaccinated, those who have been previously infected, and those who will become infected during the Delta wave, a very large majority of the population in the US will carry partial immunity to Covid-19. Increasing partial immunity will make severity of disease less likely as time goes on, even as future variants emerge. It is possible that it will take the evolution of a variant with much enhanced immune-evasion ability or much greater pathogenicity to generate significant mortality in future waves. We do not know whether such a variant will emerge.

Revised CDC Guidelines on Masking and Testing for the Fully Vaccinated (new)

Data from the Provincetown cluster and other data presented this week led the CDC to revise its guidelines with respect to masking and testing for those who are fully vaccinated. The CDC is once again recommending that everyone wear masks in public indoor spaces in communities where there is significant viral transmission, regardless of vaccine status. The CDC is also recommending that those who have a known exposure be tested 3-5 days later, even if they are fully vaccinated.

We agree with these recommendations, at least for the duration of the Delta wave. The primary reason is to curtail spread among the unvaccinated. Universal masking requirements, when followed, are effective in this pursuit. Masking will also reduce the likelihood that the vaccinated will contract the disease and spread it to family members who are not yet vaccinated or are immunosuppressed. We are not worried that the vaccinated will develop severe symptoms themselves if they contract Delta – this is likely to remain an extremely rare occurrence.

Moderna/CMG Pediatric Vaccine Trial – Stage 2 (new)

We are happy to report that CMG has been given 90 slots for children age 6-11 in Stage 2 of Moderna’s KidCOVE pediatric vaccine trial. We expect enrollment for Stage 2 to begin in the second week of August. Stage 2 is the placebo-controlled portion of the study in which ¾ of enrolled children will receive two doses of the vaccine while the other ¼ will receive two doses of placebo. Families will not know whether their children receive vaccine or placebo. If either the Moderna or Pfizer vaccine is approved for general use in this age group while the study is ongoing, children who received placebo will be offered the vaccine through the study.

We have begun contacting families that have previously expressed interest in participating in the study. If you have not yet expressed interest but would like to do so now, the Interest Form can be found here. Please fill out only one form per family – multiple children can be entered on the same form. We will offer participation to as many families as we possibly can. If there are future opportunities to enroll additional children in this age group or younger age groups, we will let you know in this space.

Status of the Pandemic in the United States and the World (updated)

The situation in the United States worsened significantly over the last two weeks. The 7-day average of new cases, number of hospitalizations, average deaths per day and test positivity rate all increased susbstantially. 122,000 new cases were identified Friday alone, the highest number since early February.

The 7-day cumulative number of Covid-19 cases per 100,000 people in the United States currently stands at 161, up dramatically from 63 two weeks ago and 28 four weeks ago.

The 7-day average number of new cases per day in the United States is currently 77,000, up from 31,000 two weeks ago and 12,000 four weeks ago. The United States recorded roughly 541,000 total new cases in the last week. This represents 13.6% of all new cases worldwide. The United States has 4.25% of the world’s population.

The national test positivity rate currently stands at 7.3%, up from 4.8% two weeks ago and 2.0% four weeks ago. This is the highest test positivity rate since February.

The number of people currently hospitalized with Covid stands at 45,000, up from 32,000 last week and 24,000 and 19,000 the two weeks prior. Hospitalizations are now level with the spring peak fueled by the Alpha variant.

An average of roughly 310 deaths per day were recorded in the United States this week, up from 275 two weeks ago and 175 three weeks ago. As of Saturday morning, the pandemic had killed roughly 613,000 people in the United States.

All 50 states and the District saw a substantial increase in new cases over the last two weeks. 42 states saw new cases increase by 100% or more in that time; 13 of these increased by 200% or more. The current top 10 states (cumulative 7-day case rate per 100,000 population): Louisiana 623, Florida 518, Arkansas 427, Mississippi 350, Missouri 301, Alabama 266, Oklahoma 238, Nevada 238, Alaska 224, and Texas 210. Again, the national number is currently 161 cases per week per 100,000 people.

The per capita numbers in our region (cumulative 7-day case rate per 100,000 population) worsened over the last two weeks: Maryland 42 (up from 14 two weeks ago), DC 63 (up from 28 two weeks ago), and Virginia 70 (up from 28 two weeks ago). Virginia, Maryland and DC are 35th, 41st, and 46th on the list this week.

Roughly 20 populous nations have higher per capita rates of disease than the United States at the moment. The top 10: Cuba (525 cases per 100,000 population this week), Georgia 490, Botswana 392, Malaysia 357, Spain 357, UK 287, Libya 287, Mongolia 280, Kazakhstan 273, and Iran 245.

Status of the Pandemic in the Washington Area (updated)

New cases reported in DC averaged 61 per day this week, up from 28 two weeks ago and 9 three weeks before that. To this point DC has documented roughly 50,400 cases and 1,150 deaths. New cases in Montgomery County averaged 57 per day this week, up from 19 two weeks ago and 6 three weeks before that. Montgomery County has now recorded roughly 72,000 total cases and approximately 1,585 deaths.

Statistics – CMG Tests for Active Disease (updated)

CMG recorded 17 positive tests for active disease this week, up from 8, 7 and 4 the three weeks prior. Some of the positive tests this week occurred among those who had been fully vaccinated or were infected by people who had been fully vaccinated.

Group Virtual Visit Offerings – Catalogue of This Week’s Sessions (updated)

Please see below the schedule for our Virtual Group Visit offerings this week. All sessions will take place on Zoom. We expect most sessions to have between 4 and 15 participants. The sessions are meant to be participatory, but if you prefer to keep your camera off and your microphone muted, you are welcome to do so. Questions can be posed directly by voice, or indirectly through the chat function. Sessions will be billable to insurance as would a normal visit with your provider.

If there is a session you would like to join, please email This email address is being protected from spambots. You need JavaScript enabled to view it. or call the office at 301-907-3960. Please include the name and date of birth of the patient, the session you would like to join, the provider who is leading it, the day and the time. We look forward to seeing you online!

Group for New Parents -- Zoom version!

Dr. Ana Markovic & Lactation/feeding Consultant Holly McClain, RN

Formerly "Mommy and Me", and now welcoming both Dads and Moms

Tuesdays 1-2pm, starting 8/3/2021. See detailed schedule below.

Virtual parent support group session starting at CMG! This group is ideal for parents of 2 week to 4 month old babies. Weekly sessions will be led by Pediatrician Ana Markovic and lactation/feeding consultant Holly McClain. Each week we will focus on a different topic, though will also cover any particular topics of interest to the group that day. Topics include breastfeeding and feeding support, discussion about sleep strategies, nutrition, finding balance, Infant development, and most of all getting to know other new parents and sharing experiences. Our traditional ways of connecting with each other have been turned upside down and this will hopefully be a welcome source of information as well as an opportunity to connect with others who may be in a similar situation.

Sign up for the whole 4 session-series or drop in for one session. New series begins soon:

Tuesday 8/3/21, 1-2pm - focus on Feeding

Tuesday 8/10/21, 1-2pm - focus on Sleeping

Tuesday 8/17/21, 1-2pm - special session on Infant Massage

Tuesday 8/24/21, 1-2pm - focus on Infant Development (0-12 months)