Excerpts from this week’s report below.
Arizona has now clearly transitioned from a period of crisis to one of elevated risk. With continuing, albeit slower, improvements being forecast for the coming weeks, hospital capacity will remain adequate to meet Arizona’s most critical needs for the foreseeable future. However, it will be several months before the backlog of non-Covid care is fully addressed.
This week saw a sixth straight week of meaningful declines in Covid-19 cases and hospital occupancy. Nevertheless, absolute levels of SARS-CoV-2 viral transmission remain above the 100 new cases per 100,000 residents per week threshold which approximates elevated risk.
As of February 21st, new cases were being diagnosed at a rate of 135 cases per 100,000 residents per week (Figure 10). This rate is declining by 30 cases per 100,000 residents per week. The pace at which conditions are improving is slowing. It is possible that we might see improvements cease before April.
Despite these improvements, Arizona has the 17th highest viral transmission rate in the US according to the CDC. With regard to cases, Arizona remains the 6th hardest hit state overall.
All residents should continue to wear a mask in public, avoid social gatherings, maintain physical distance from non-household contacts, avoid >15 minutes contact in indoor spaces, especially if physical distancing is inadequate and adherence to face masks is low.
While residents and businesses should continue to follow the recommended public health mitigation efforts, normalization of lower risk activities will be reasonable once case rates fall below 100 new diagnoses per 100,000 residents per week.
The test positivity rate for traditional nasopharyngeal PCR testing was unchanged this week at 15% indicating testing is inadequate to the scale of the problem as positivity should be <10%.
Moving forward it will be necessary to remain adherent to our public health mitigation practices in the face of improving conditions. For example, absolute levels of transmission and test positivity remain about 1.5X higher than recommended for in-person instructional activities (see Arizona Department of Health Services Benchmarks).
Hospital Covid-19 occupancy continues to decline in the ward and ICU. Access to care, while somewhat restricted, is being scheduled at greater frequency. Nevertheless, it will be several months before the backlog of medically necessary non-Covid procedures is addressed.
According to the CDC, 6.7% of Arizona residents have received at least 2-doses of vaccine while another 9.7% have received 1-dose. The ADHS Dashboard is reporting slightly higher levels. To date, Arizona has administered 84% of its delivered doses.
NPR released a well-done simulation/animation that shows the impact of past infections, vaccinations, and increased transmissibility on future cases among remaining susceptibles.
Arizona is still reporting a large number of weekly deaths and this count may considerably underestimate true fatalities. The week ending January 17th will be Arizona’s deadliest with >1000 deaths. Arizona’s weekly tally of deaths ranks it 5th in the nation. Overall, we rank 6th since the outbreak began.
FDA Authorizes Emergency Use of the Johnson & Johnson Vaccine: CDC Likely to Recommend It’s Use Later Today
The FDA’s review committee met last Friday to discuss the Johnson & Johnson’s application for emergency use of their vaccine in the U.S. and recommended that the FDA commissioner authorize use of the vaccine. The FDA Commissioner signed the official authorization last evening.
The CDC’s Advisory Committee on Immunization Practices is meeting this afternoon to discuss whether the vaccine should be given to Americans. The ACIP will vote on their recommendation this afternoon and I expect the CDC director, Dr. Rochelle Walensky, to make the final decision to release the vaccine this evening.
The FDA posted all the J&J vaccine applicatio data on their website. There are several documents in the meeting packet but the one that I like to look at is the FDA’s briefing document to the committee.
The results from the Phase III clinical trial look good (40,000 participants in the trial). Here’s the bottom-line effectiveness (from the summary report):
“… vaccine efficacy against central laboratory confirmed and blind-adjudicated severe/critical COVID-19 occurring at least 14 days and at least 28 days after vaccination of 76.7% and 85.4% respectively.”
In other words, this single dose vaccine is 77% effective at preventing severe COVID disease 14-days after the jab and 85% effective after 28 days.
There were 2 hospitalizations from COVID in the vaccine group (both before 28 days post vaccination) compared with 29 cases in the placebo (saltwater injection) group. None of the persons that were given the vaccine died while 7 people died of COVID in the placebo group.
The vaccine worked equally among subgroups in the trial (age, comorbidity, race, ethnicity) but effectiveness among folks 60 years of age and older with comorbidities was a little lower early on in the study (i.e., counting cases from 14 days rather than 28 days and including cases not yet centrally confirmed).
Side effects within 7 days of injection were the statistically the same among the vaccine and placebo (saltwater) groups. In other words, side effects were no different whether the person got the vaccine or the saltwater injection. Those side effects included injection site pain (48.6%), headache (38.9%), fatigue (38.2%), and myalgia (33.2%).
The independent review committee concluded that:
“… the analysis supported a favorable safety profile with no specific safety concerns identified that would preclude issuance of an EUA”.
Note: Globally and in the U.S. this is a very important vaccine. It is simple, inexpensive, doesn’t require complicated storage and handling, and (perhaps most importantly) is a single dose vaccine. This vaccine belongs in doctor’s offices, pharmacies, and community health centers… using it at mass vaccination sites would be a big mistake because one of this vaccine’s strengths is its flexibility.
This vaccine’s flexibility means that we can bring the vaccine to the people rather than bringing the people to the vaccine… which can help us overcome the large disparities that exist in Arizona: