Jose Romero , MD
Col . Ator is a veteran of several major combat operations including Operation Desert Shield and Operation Desert Storm in Saudi Arabia , Iraq , and Kuwait . A respected pilot , he was honored with the Air Mobility and Air Education and Training Commands ’ prestigious McKay Trophy and Jabra Awards .
COVID-19 Update with Arkansas Department of Health
Dr . Romero presented an update on work done by the ADH and data pertaining to the virus in its variant strains , vaccines , and vaccine uptake . Beginning by expressing gratitude to physicians , he said , “ I want to thank practicing physicians in this state for all the work you ’ re doing to bring this pandemic under control .”
Giving a recap of the pandemic , Dr . Romero shared that it blossomed last year into a worldwide problem with currently over 161 million cases and 3.3 million deaths . In the U . S ., there are currently more than 32,800,000 plus cases and more than 584,487 deaths . The country has lost roughly $ 2 billion in gross domestic product . during this epidemic ( May 14 data ).
Bringing it local , he gave a recap of Arkansas ’ s experiences so far and honed in on the number of cases and the effects on health care workers . The first case in Arkansas occurred on March 11 , 2020 , and as of May 14 , we have had just over 338,000 cases . Of those , health care workers account for 5.4 % of those cases . “ You can see that the nurses , because they are at the bedside , have born the brunt of this ,” said Dr . Romero . “ About one-third of all cases affect RNs and CRNs . For physicians , it ’ s about 450 individuals . Hospitalizations statewide are at about 16,000 , and we continue to see between two and seven deaths a day , but I can tell you that the number of deaths has plummeted since we began vaccinations .”
Dr . Romero took a few moments to describe the viruses themselves and how the different vaccines work , and focused on related challenges that are coming up for our state . “ First and foremost , I think the variants are most important because that has an impact on our vaccination strategy and our need to become vaccinated .”
Arkansas started with 11 variants in early April and is now at 32 . Dr . Romero concentrated on “ variants of concern ” for their evidence of increased transmissibility , more severe disease , significant reduction in neutralization by antibodies generated during previous infection or vaccination , reduced effectiveness of treatments or vaccines , or diagnostic failures . These include Variants B . 1.1.7 from the UK , B . 1.135 from South Africa , and P . 151 from Brazilian origin . Some variants are more successful at overcoming the effects of a vaccine , particularly the Brazilian variant .
In our area , B . 1.1.7 is the dominant mutant , but there are other mutants listed here also . “ Any of these [ mutants ] can jockey into a higher position depending on the number of individuals they ’ re able to infect ,” noted Dr . Romero . “ That is why we want to get everybody vaccinated as soon as possible . Each individual person that is not vaccinated serves as a vessel , if you will , to develop a new variant or to spread the new variant effectively .”
Vaccines and Adverse Effects
Dr . Romero summarized the Emergency Use Authorization ( EUA , not FDA ) approved vaccines in the U . S . – the Pfizer Bointech mRNA vaccine , the Moderna mRNA vaccine , and the Johnson & Johnson Adenovirus vector vaccine . The Pfizer is 95 % effective , good against almost all strains . Moderna has an efficacy of 94.1 %, good against most strains . In describing the Johnson & Johnson vaccine , he said , “ What ’ s interesting about the efficacy is that it reflects the variants that are circulating in each country . So , overall the efficacy is 66 %, but in the United States , it ’ s 72 % total , but 100 % for hospitalization and death . In South Africa , where the predominant strain is the B . 135 strain , it ’ s 66 % and it ’ s further decreased in South America , where the P . 151 strain is primarily found . So , if [ these , referring to the mentioned variants ] take hold here , we will lose the efficacy of our vaccines .”
He talked through some of the adverse effects of the vaccines , of which physicians will already be aware . Adverse effects for Pfizer and Moderna include anaphylaxis , he noted , adding that they typically occur primarily in young women , within 30 minutes after receiving the vaccine . “ There have been no fatalities due to these [ at last check ],” he said . “ Physicians should be prepared for these types of reactions and have epinephrine , Benadryl , and hydrocortisone around to deal with it . We know that this is a rare event , but our patients should know .”
Recently , for the Johnson & Johnson vaccine , we have the adverse effect of Thrombosis with Thrombocytopenia Syndrome ( TTS ). This
12 • The Journal of the Arkansas Medical Society www . ArkMed . org