Update 6-4-21: The 7-day rolling average is now 36.4 cases per day in Cuyahoga County. For the last three weeks, cases have dropped about 25% per week.

Update 5-28-21: Currently Cuyahoga’s 7-day rolling average is just under 51 cases per day. This is down from 66 cases a week ago and around 90 cases two weeks ago. While these numbers will go up as more cases are reported to the Board of Health, the trend is continuing to drop significantly on a weekly basis. At the same time, patients are telling me of friends and family catching Covid in the last couple of weeks. Stay smart and be careful.

First, I was mistaken, we are not currently entering a 4th Covid wave ^[1]. Cases are coming down, with our 7-day average just under 40,000 new cases per day ^[2]. This is the lowest that they’ve been since last September. Hospitalizations are down as well as deaths which are currently a little over 600 per day. This is the best since last July. In Cuyahoga County, we are currently seeing about 90 new cases per day ^[3], which is the best we’ve done since before Thanksgiving.

The B.1.1.1.7 variant (originally found in the UK) is still predominant ^[4], making up 60-70% of new cases. The second most common variant is B.1.526 which was originally found in New York City. Current vaccines are very effective against both of these variants ^[5]. The vaccines are also effective in preventing deaths and hospitalizations against the B.1.351 (South African) variant, but it isn’t spreading too much. The P.1. variant, which was originally found in Japan, but has spread extensively in Brazil is now over 5% of the US cases ^[4]. Fortunately, the P1 variant seems to be less resistant to the vaccines than originally feared ^[6]. The B.1.617 variant which is currently affecting India, has been labeled another variant of concern ^[7] by the WHO. While there have been cases reported in the US, our current vaccines seem to be effective against hospitalizations and death. ^[8]  Again, these variants of concern are more lethal and spread easier ^[9]. Manufacturers are also developing booster shots ^[10] against these variants that will probably be available in the fall.

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Other studies are showing a real-world difference with the vaccines. The Cleveland Clinic did a study that shows that more than 99% of the people hospitalized with Covid weren’t fully vaccinated ^[11]. Currently, almost 37% of Ohioans are fully vaccinated ^[12], and while infections have dropped, there are still a significant number of new cases. Finally, the predominant variants that we are currently facing spread much easier than the original variant. Add this together and we are finding younger unvaccinated people are seeing a rise in Covid infections and hospitalizations ^[13]. It is important for unvaccinated people to not let their guard down ^[14]. 

The Johnson and Johnson vaccine was halted last month because women between the ages of 18-60 developed blood clots. Usually, blood clots are treated with Heparin, but in this case, it made the women’s conditions worse. A total of 28 women were affected before the April 13th pause, with three deaths.  The use of Heparin has been replaced with different anticoagulants that are effective against this type of clotting. The knowledge of what to look for and how to treat this side effect greatly reduces the risks from this vaccine. Almost 9 million people have been given the Johnson and Johnson vaccine ^[15]. Once manufacturing issues are cleared, there should be an increase in availability and I believe is a reasonable choice between effectiveness against death and hospitalizations and convenience and reduced side effects. 

Governor DeWine recently announced a lottery incentive to push people to get vaccinated ahead of reopening the state fully on June 2nd. ^[16] Please note, we will not change any of our procedures for at least two weeks. Ohio businesses will still have the choice to require masks upon entering. Lydia and I have been talking about what changes we will implement at first. Some thoughts are to stop wiping down seldom touched surfaces like bottles, leaving bleach solutions in the restrooms for patients to wipe surfaces if they wish, to allow patients to pass in the hall, and to start using our waiting room again. Because Covid is an airborne disease ^[17], I will continue to require masks for a while. Originally, I was thinking that I would stop requiring masks after Cuyahoga’s daily average was under 7 per day for two weeks. We welcome your input. Again, we will keep with our current protocols until at least June 16. 

For those that have been following Vita’s (our daughter) boyfriend’s recovery, it’s been over two weeks and he is still in the ICU. His doctors are hopeful that he will be able to be moved to a rehab unit this week. Vita says thank you to all who have donated, sent well wishes, and prayers. You can read the original post here ^[18].

A PDF of this article, with citations is here ^[19].