COVID-19 - Dr. Jim Halverson

Ask Dr. Halverson: Vaccinations, mitigation compliance having great success against COVID-19 locally

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By Dr. Jim Halverson
The April 23 COVID-19 statistics for Ventura County were published with little fanfare.
But the numbers were hugely significant. On that day, there were only nine patients hospitalized in Ventura County with COVID-19 and none were in the intensive care unit. This is the first time in over a year that no COVID-19 patients were in county ICUs.
Hospitalization and ICU numbers are, in my opinion, the best measures to monitor for the current impact of COVID-19 infections in our county. Until all eligible individuals who want to be vaccinated are fully immunized (two weeks after their last vaccine dose), cases should be expected to continue at some level every day. However, with vaccine rates now more than 80% for people over 65 in our county, and many other highly vulnerable individuals also being fully vaccinated, the severity of COVID-19 cases has been significantly reduced. Most reported cases are now occurring in individuals under 65 who have yet to be vaccinated or those who have declined the opportunity to receive the vaccine.
Patients with COVID-19 requiring ICU care are extremely sick. Many are on ventilators. They are often unable to have meaningful interaction with loved ones as patients on ventilators require heavy sedation. In addition, the length of ICU stays for these patients is often weeks, and for some, even months. Unfortunately, many eventually die.
Just over three months ago, in mid-January, Ventura County was reporting more than 400 patients hospitalized with COVID-19 daily, with nearly 100 of them in ICUs. Community Hospital in Ventura had nearly 100 COVID-19 patients, representing 40% of their available beds. Up to 20 of those patients were in the ICU, often with more than half on ventilators. Visitation was not allowed. Elective surgical cases were canceled. Staffing was difficult, as many of the hospital workers either had COVID-19 or were quarantined at home due to exposure to the virus. It was an extraordinarily challenging time and I applaud how well our hospitals and public health officials handled that health care crisis.
In January, the vaccine rollout had just begun. No one had yet reached full immunity from the vaccines that does not occur until two weeks after the second dose.
Fast forward to the end of April. More than 625,000 doses of vaccines have now been given to county residents. Fifty-eight percent of individuals 16 and over have received at least one dose of a vaccine and 40% are fully immunized. More than 30,000 vaccines are being given every week.
In the Ojai Valley, the numbers are even better. After another very successful vaccination clinic at Nordhoff High School on Saturday, April 24, more than 60% of our valley residents have received at least one dose and more than 41% are fully vaccinated. We have among the highest vaccination rates in the county. This would not have happened without the amazing efforts of Ojai Valley Community Hospital, Help of Ojai, the Ojai Unified School District and many devoted volunteers.
There is more very encouraging news. For all individuals 16 and over who have yet to receive the vaccines, the Nordhoff High School site will have five more Saturday clinics (May 1 through 29). The Pfizer vaccine is being given, which will enable you to get both shots three weeks apart without leaving town. Vaccine appointments can be made at https://myturn.ca.gov. 
In addition, several of our local pharmacies are also offering COVID -19 vaccines, including Medical Arts, Medicine Shoppe, Rite Aid, and Ojai Village Pharmacy. To make an appointment with them go to www.venturacountyrecovers.org and click on the Vaccine Appointment Information link. If you do not have computer access, call the California COVID-19 Hotline at 1-833-422-4255. Help of Ojai is also available to assist those 65 and over who are finding it challenging to schedule a local appointment.
Thanks to all of you who continue to follow the mitigation measures of social distancing, hand hygiene and mask wearing and to the many thousands of you who have or will be getting vaccinated against COVID-19. Together, we are all making ourselves, our families, our friends, our neighbors and our community a much safer place to live.

 

Johnson & Johnson / Janssen vaccine update
On April 23, an advisory panel for the Centers for Disease Control and Prevention decided that use of the Johnson & Johnson/Janssen vaccine should resume in the United States for all adults 18 and over.
The Advisory Committee on Immunization Practices voted for that recommendation. The announcement comes with an updated warning directed at women under age 50 who have an increased risk for a rare but serious blood-clotting disorder called thrombosis with thrombocytopenia syndrome (TTS).
As of April 21, 15 cases of TTS, with three deaths, all in women and 13 of them in women under age 50, have been confirmed among 7.98 million doses of the J&J/Janssen vaccine administered in the United States.
Symptom onset (severe headache, new neurological symptoms, shortness of breath, severe abdominal pain, leg swelling, or new and easy bruising) seems to occur between one and two weeks after vaccination. Characteristics of case patients include a median age of 37 years and median time to onset of eight days. Twelve of the 15 cases were cerebral venous sinus thrombosis cases, which presents with severe headache or new neurological symptoms. No cases have occurred in pregnant or postpartum females.
Even though headache is a common symptom after COVID-19 vaccines, the headaches with TTS typically appear after six days rather than a day after the injection.
Although no TTS cases have been documented in men in the United States, it does not mean there is no risk for males. There may be cases that have not yet been identified or reported.
The recommendation allows for flexibility in choice for vaccines and allows continued use of the J&J/Janssen vaccine in harder-to-reach populations. Each individual should try to understand the risks and benefit of the J&J/Janssen vaccine. Local health care providers and our Ventura County Public Health Department should be able to provide that information.
Overall, with the resumption of the vaccine in adults 18 and over, modeling predicts that 26 cases of TTS would occur among the nearly 10 million persons who are likely to receive the vaccine in the next six months. The highest-risk group (women ages 30- to 39) would be expected to have 12 cases per 1 million vaccinations. About 2,200 deaths would be prevented in those 10 million vaccine recipients.
Please discuss the risks of this vaccine with your health care provider or public health officials if you have any concerns. Also, remember that no cases of TTS have been reported with the Pfizer or Moderna vaccines.
Stay properly informed, follow the guidelines, stay hopeful, stay safe and stay well.

— Dr. Jim Halverson is a longtime Ojai physician who writes a weekly column on COVID-19 for the Ojai Valley News.