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COVID-19 UPDATE

tant finding is that heparin antibodies are present in this condition, so At the time of this writing, more than 50% of Texans 12 years of
other anticoagulants must be used for treatment of these clots. age and older have received at least one dose of vaccine. Bexar County
Current recommendations are that persons who have already had has exceeded 1 million doses given and the majority of seniors have
COVID should still be vaccinated. The degree of natural immunity been vaccinated. Among the total Bexar County population, more
after vaccination varies, and reinfection can occur. There is not a rec- than half have received at least one dose and over 40% are fully vacci-
ommended minimum interval for the vaccine after infection, but re- nated. See the COVID-19 page at sanantonio.gov for the most up-
infection is uncommon before 90 days. Persons with COVID should to-date information from Metro Health.
defer vaccination at least until recovery from acute illness and criteria This is encouraging news, and yet the pace of vaccination in the U.S.
for discontinuing isolation is met. has slowed. Strategy has shifted from mass vaccination to mobile vacci-
At this time, the FDA recommends against the routine use of anti- nation, pharmacies and physician offices to make vaccination more con-
body testing for detection of vaccine antibody response. Many FDA- venient. Vaccine hesitancy is more common in rural areas, and
authorized antibody tests detect nucleoproteins that are the result of vaccination rates also vary a great deal by state. Most hesitancy is related
natural infection and not spike protein, which is what vaccines are di- to concerns about side effects. Surveys continue to show that a person’s
rected against. Even with tests detecting spike protein antibodies, stud- most trusted source of information about vaccines is their personal
ies continue regarding the amount of antibodies that are protective health care provider, so physician discussions with their individual pa-
against infection. Commercially available antibody tests do not detect tients about the vaccine are key. Vaccination rates high enough to
neutralizing antibodies. achieve herd immunity in all geographic areas of the U.S. may be elusive,
The need and timing for booster doses have not been established, however, and we may have to be prepared for another increase in cases
but it is likely that a booster will be advised around the end of the year. next winter, since coronaviruses are typically a fall/winter seasonal virus.
The vaccines currently authorized by the FDA appear to have efficacy Countries leading the world in vaccination rates include Israel,
against variants of concern, although responses may be diminished for United Arab Emirates, Bahrain, Chile and the UK. Clinical study re-
some variants. As the virus continues to spread in areas around the sults of the efficacy and safety of vaccines used in many other areas of
globe, the development of new variants is concerning. the world, such as Sinovac/Coronavac (inactivated virus technology;
Early studies in immunosuppressed persons indicate that they may China) and Sputnik V (adenovirus vector technology; Russia) are not
have less antibody response. Depending on the results of ongoing stud- as well-known, and real-world data will be telling.
ies, earlier boosters in this population may be warranted, but as of this While vaccination rates in the U.S. are encouraging, the battle
writing, this is not yet recommended. against COVID-19 is still fierce in most parts of the world. The cur-
The adenovirus vector Oxford/Astra-Zeneca vaccine, used widely rent situation in India is an example. In the month of May, India re-
in the United Kingdom and some other countries, is not yet FDA-au- ported more COVID-19 deaths in a single day than any other country
thorized in the U.S. and has also been noted to be associated with during the pandemic.
TTS. In addition, studies show there are concerns with efficacy against The efficacy of vaccines authorized in the U.S. and the speed with
the South African variant. Clinical trials with Novavax, a recombinant which they became available is phenomenal and we are indeed fortu-
protein plus adjuvant vaccine, appear very promising, but FDA au- nate to have had the government’s support, innovative technology, sci-
thorization is not expected until later this summer. entific expertise and willing study volunteers to achieve such success.
Influenza was virtually nonexistent this past winter season, but Because the virus knows no borders, however, we are not safe until we
without masking and distancing next winter, it is expected to return. are all safe, and the U.S. can play an important role in controlling
A combination of flu/COVID vaccine could be desirable, and No- COVID-19 worldwide by making its plentiful supply of vaccines
vavax has announced promising preclinical data with a combination available to other countries.
vaccine. Clinical trials with this combination vaccine are expected to
begin before the end of the year. Jan E. Patterson, MD, MS, MACP is a Professor of
The U.S. is on course to achieve the Biden administration’s goal of Medicine/Infectious Diseases at the Lozano Long School of
70% of adults receiving at least one dose of vaccine by July 4, 2021. Medicine. She has more than 30 years of experience in in-
By the third week in May, over 60% of adults have received one dose. fection prevention and has been involved in the COVID-19 response
Around 40% of the total U.S. population is fully vaccinated. Several for the South Texas Regional Advisory Council, UT Health, Univer-
states have achieved at least one dose to 70% of their adult population. sity Health and Metro Health. She is a member of the Bexar County
See the CDC COVID Data Tracker for updated numbers. Medical Society.

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