by Michael D. Cohen MD

Course of the Pandemic

The United States has lately stabilized at around 60,000 new infections per day. This is not good, as daily infections need to go down much further before control of the pandemic can be achieved. At least deaths and hospitalizations have continued to decrease.

However, the new virus variants B.1.1.7 and P1 are present and circulating in the US. B.1.1.7 is spreading rapidly and now accounts for up to 40% of infections in some areas. The state of Michigan and the New York City region have the highest rates of infection as of publication time.

Public health and government leaders are warning of the risk of more widespread disease and urging greater efforts at prevention right now before the virus spreads out of control again. Governors are intent on opening up indoor dining, bars, sports events, and more without masks, keeping a safe distance apart or improved ventilation systems. A perfect storm of unsafe behaviors and much more infectious virus strains could fuel a third wave of the COVID-19 pandemic.

In February, a guard infected with B.1.1.7 introduced it into a Michigan prison. By mid-March over 400 prisoners in 3 Michigan facilities had been infected with that more infectious variant.

Articles in medical and public health journals have demonstrated that infection rates among incarcerated people in prisons and jails are 5.5 times the rates in the general population. Also, infection rates among guards are three times the rate of the general public.

Vaccines

The national rollout of vaccinations has proceeded rapidly. More than three million doses are being given per day.

In New York, vaccines have not been widely available to prisoners. Ruling on a lawsuit filed by prisoner advocates, a state court has ordered the government to provide vaccines to people residing in state prisons and jails, just as they have already provided vaccines to those residing in other higher risk congregate living institutions like mental hospitals, developmental centers, and residential drug treatment programs. This is a rare but important legal victory for prisoners in New York.

Follow-up studies of vaccine effectiveness have shown that antibody responses to the Moderna and Pfizer vaccines are still strong six months after the shots were given. This is good news, as the longer the response lasts, the better people are protected.

Surveillance of side effects and complications associated with vaccines identified some very rare blood clots in the brains of younger women who received the Johnson and Johnson (J&J) vaccine. As a result the government ordered a pause in use of the J&J vaccine while experts reviewed the initial seven cases to determine the nature of the risk and what should be done about it. There is no evidence at this time that the vaccine is the cause of these blood clots, but the timing of the clots close to the time of vaccine administration suggests they may be related.

With more than seven million J&J doses administered, seven cases are very rare indeed (less than one per million overall). If just younger women who received the J&J vaccine are counted, the rate is about one in 250,000 doses, still very rare. Compare this to the risk of being struck by lightning, which is one per 500,000. The recognition of rare cases of blood clots associated with a vaccine shows that surveillance is working well to identify even rare events that may be vaccine related.

The risk of harm from COVID disease are far greater than the very rare risks that may be associated with the J&J vaccine. It is likely that the J&J vaccine pause will be lifted later this month, perhaps with restrictions on its use for women 18 to 49 years old, who may be at greater risk for blood clots.

Staying Safe

This month the US Centers for Disease Control (CDC) issued new guidance that substantially relaxed recommendations for cleaning and disinfection of surfaces to prevent COVID. This was done because we know now that COVID is largely transmitted via droplets or aerosols inhaled from the air, not from contaminated surfaces.

But contaminated surfaces are still one of the sources of infection. In their new guidance, CDC also recommended that decontamination of surfaces should be continued in locations where recent cases of infection have occurred. Because prisons and jails are places where recent cases have occurred, there should be no relaxation of surface decontamination and personal hygiene among the incarcerated. In congregate living conditions the risk is always there. Keep protecting yourself and others.

Long Term Effects of
COVID 19 infection

A study published this month in Lancet Psychiatry analyzed mental illness and physical disorders of the brain and nerves during six months following recovery from COVID infection. They found substantial numbers of people had a wide variety of medical and mental health disorders following COVID-19. Overall, about 12% of people recovered from COVID had a new diagnosis of a neurological or psychiatric disorder. For those who had more severe disease, 26% had a new neurological or psychiatric diagnosis. Comparison groups of people with influenza and people with pneumonia did not have similar incidence of new neurological diagnoses. This is very troubling information, as it demonstrates substantial continuing neurological disease and mental illness among COVID survivors.

Conclusions

Where are we today in the pandemic?

Coming out of it with vaccines widely available and cases, hospitalizations, and deaths down compared to the recent winter months?

Or:

On the cusp of another widespread surge of cases due to the more infectious variants that are already in circulation?

What people and institutions continue to do now to prevent new infections can make a difference. Time will tell. 

Michael Cohen was the medical director for the New York state juvenile justice system for 20 years and previously provided medical care for incarcerated adults at the New York City Rikers Island jail and at Greene CF in Coxsackie, New York. For 10 years, he participated in a support group for people with diabetes at Great Meadow CF in Comstock, New York. With the group, he co-authored the Prisoner Diabetes Handbook published by Southern Poverty Law Center and distributed by Prison Legal News. Heal the sick. Raise the fallen. Free the prisoners.

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