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David Katzman, MD & Jennifer DeLaney, MD Internal Medicine Specialists |
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When Can Things Go Back to Normal?
Jennifer DeLaney, MD
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As vaccinations have ramped up and local rates of COVID-19 infections have declined, the risk of developing COVID-19 is thankfully much lower than it was a few months ago.
Many of you are left wondering, "When can things go back to normal?"
If you are 2 weeks post your second dose of Pfizer/Moderna or 2-3 weeks post your dose of Johnson and Johnson vaccine:
- You can socialize indoors with a small (4-6 people) group of fully-vaccinated people without wearing a mask.
- You can socialize indoors with one household of non-vaccinated people. "For example," the CDC wrote in a statement, "fully vaccinated grandparents can visit indoors with their unvaccinated healthy daughter and her healthy children without wearing masks or physical distancing, provided none of the unvaccinated family members are at risk of severe COVID-19." If any of your party are particularly high-risk (compromised immune system from chemotherapy, autoimmune disease, etc), I would still wear a mask when you are not eating.
- In indoor public places you should wear a well-fitting surgical mask or KN-95 or N-95 mask. Your risk of infection is low, but out of respect for others who do not know you are vaccinated, you should continue to wear a mask.
- In outdoor spaces that are not crowded, you do not need to wear a mask.
- You can travel but should wear a well-fitting surgical mask, KN-95, N-95 mask for the entire time you are in the airport, on plane, etc. Eye protection, such as a face shield or tight-fitting glasses is also a good safety feature. Don’t eat or drink on a plane if it can be avoided.
- You can eat outside at a restaurant. Out of courtesy, put a mask on when the server approaches the table.
- I still would not eat inside at a restaurant until May or June when the majority of adults will have been vaccinated.
For those who are not vaccinated:
- Continue to follow previous safety guidelines. Whenever you are around people outside your household, keep your mask on. Don’t fly, don’t eat indoors at restaurants, and also, don’t despair - you should be able to get vaccinated by the end of May or June at the latest!
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COVID-19 Mutations: What You Need to Know!
David Katzman, MD
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I’m sure you have heard about the Covid-19 variants, produced by mutations in the RNA of the virus as it replicates. While most mutations don’t change the virus’s function, some have been identified that either help the virus latch onto and enter cells, or better evade tagging and destruction by the immune system.
The B.1.1.7 variant, first discovered in the UK, is by far the most common. The mutation affects the “spike” that allows the virus to enter human cells, making its entry more efficient with an estimated 50% increased rate of transmission than the original virus. The B.1.1.7 variant's share of U.S. cases has recently grown exponentially to roughly 20% of new Covid cases, even as total cases have recently improved. Fortunately, this mutation does not appear to affect the efficacy of any of the vaccines. There are more than 30 times as many cases of B.1.1.7 than the other two variants first reported in South Africa (B.1.351) and Brazil (P.1).
Both of these other variants, B.1.351 and P.1, have the same mutation as B.1.1.7 which increases the rate of transmission but have a second mutation that diminishes the ability of antibodies—naturally acquired or vaccine-generated—to neutralize the virus. There is concern that these variants can lead to more severe infection or reduce immunity derived from a previous infection or a vaccine. For example, lab tests examining blood from vaccinated people tend to produce fewer antibodies that fight these variants. In addition, the city of Manaus in Brazil recently faced a viral surge this winter of the P.1 variant even though 75% of its population was thought to have been infected by the original virus in the fall.
While there are plenty of reasons for optimism given the recent declines in infections, hospitalizations and deaths from Covid-19, the presence of these variants necessitates continued vigilance in social distancing and mask-wearing, as outlined in Dr. DeLaney’s article above. |
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We are continuing to try to get the COVID vaccine here at our office. Each week we place an order, but up to this point our request has not been granted. Missouri’s distribution plan allows for only 2,000 doses to go to community providers and there is a lot of competition for these as you can expect. They seem to be focusing on larger community providers first.
Please continue to sign up for the vaccine through any outlet you can. We recommend receiving the vaccine whenever/wherever it becomes available to you. We have a few new resources on this to share with you:
- Vaccine Navigator – this is a Missouri-based program. You will register and await an email once it’s your turn to schedule an appointment. You will then be presented with appointments available at vaccine events occurring around Missouri. If you do not have email or are unable to register online, please call 877-435-8411, and they have staff who will help register you.
- Vax Standy by Dr. B – this is a standby list which pairs extra vaccine doses which otherwise would have to be wasted – for instance, doses available due to unkept appointments or unanticipated extra doses drawn from the vials – to participants. This site will follow state/local guidelines for prioritization and utilize your zip code to help locate these extra doses posted by local providers. If a dose becomes available, you will receive an email and will need to quickly respond by a certain time before they will release it to someone else. If you sign up for this service, it’s important to keep a frequent eye on your email.
- VaccineFinder – this is a nationally-based program which identifies vaccine providers in your area. It lists the location information and availability of stock, however this does not guarantee this location will have appointments available. You will need to call each location to find out if they have open appointments.
In addition, we have recently been notified that once we do get the vaccine, we will be unable to vaccinate any patients who are not Missouri residents. Those residing out of state will need to receive the vaccine from their local community. This is a new constraint which most states are now implementing since their federal vaccine allotment is based on state population.
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Barracuda
We are looking into a few other secure email options for our office to utilize. Barracuda has a few quirks that may not work with our office flow. We will update you when we have the bugs worked out. Thank you for your patience!
Documenting Your COVID Vaccine
Please continue to let us know when you receive the COVID vaccine. We need both the date you received it and also the manufacturer of the dose you received. We are unable to put future dates into your records, so we ask that you email/call after you have received each dose or you may wait until receiving both doses to notify us. You are welcome to also send us a copy of your vaccine card. This documentation is important to not only keep your chart up to date, but also allows us to know how many doses we may need to administer if we do receive a vaccine allocation. |
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March is National Nutrition Month. After months of staying or working from home (with the kitchen so close by) and having decreased physical activity throughout the winter, it’s important to refocus on our nutrition! Are you ready to make changes in your lifestyle and move toward a healthier weight? The Academy of Nutrition and Dietetics offers the following recommendations:
- Start with a plan for lifelong health. Focus on the big picture of achieving overall good health – not just short-term weight loss.
- Set healthy, realistic goals. You are more likely to succeed in reaching realistic goals when you make changes step-by-step. Start with one or two specific, small changes at a time. Track your progress by keeping a food and activity log.
- Plan your meals ahead of time. Whether you’re eating at home, packing a lunch or eating out, an overall eating plan for the day will help keep you on track.
- Balance your plate with a variety of foods. Half your plate should be filled with fruits and vegetables, one fourth with protein foods like lean meat, poultry, fish or beans, and one fourth with grains. To round out your meal, add fat-free or low-fat milk, yogurt or cheese.
- Start your meal with lower calorie foods like fruits, vegetables and salads. These foods are packed with nutrients your body needs.
- Get plenty of dietary fiber from fruits, vegetables, beans and whole grains. Dietary fiber can help you feel full longer and may lower your risk for heart disease and type 2 diabetes.
- Watch portion sizes to manage your calorie intake. This is the key to an effective weight management plan. To make sure your portion sizes are “just right,” visit www.MyPlate.gov for healthy eating guidelines in household measures and refer to the Nutrition Facts Label for serving size information.
- Snack smart. Snacks can fit into a healthy eating plan, if they’re planned right. To prevent hunger between meals, choose nutritious foods from the MyPlate food groups. Keep portable, healthy snacks in your desk, backpack or car.
- Find ways to be active throughout the day. Aim for 2 hours and 30 minutes, or more, each week of moderate-intensity aerobic activity, such as brisk walking. Muscle-strengthening activities at least two days per week are also recommended. If you are currently inactive, check with your doctor about increasing physical activity first.
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Please visit our website if you have missed any past newsletters. The newsletter archives can be found by hovering your mouse over the "Medical Links" tab. |
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