COVID Vaccine Update 4/16/21- Johnson & Johnson
Johnson & Johnson vaccines remain on pause as the FDA reviews evidence of rare blood clots. The Moderna and Pfizer vaccines have not been linked with any concerns and continue to be administered. During calls on 4/14 and 4/15, physicians and vaccine researchers at the CDC emphasized that the number of reported cases has been very rare (less than 1 in 1,000,000 people). The reason for the temporary halt in vaccination is to thoroughly investigate whether additional cases of clots have occurred. The goal is to allow people to make informed decisions prior to receiving a vaccination with the Johnson & Johnson (J&J) product. It is the expectation of our Health Department that within the next 2-3 weeks, vaccinations with J&J will resume.
Of the 6 cases of cerebral blood clots reported among the 6.8 million people who have received the J&J vaccine, all were women under age 50 and happened within 2 weeks of vaccination. There was no association with pregnancy or birth control (1 of the 6 women took birth control pills and none were pregnant).
The blood clots that occurred were the result of a rare immune reaction. The AstraZeneca (AZ) vaccine available in Canada and Europe is similar in design to the J&J. The AZ vaccine has also been associated with rare blood clots (1 in 250,000 people). These have occurred at a 2:1 ratio in women vs. men. In Canada and Europe, there also has been no link between birth control or pregnancy and these blood clots.
The CDC Vaccine Advisory Committee is scheduled to meet on 4/23 to discuss additional data. It remains to be determined when they will issue more guidance. It is extremely important to the Calvert County Health Department that we provide accurate information to our entire community. Our physicians and nurses view every resident of Calvert as our personal patients. We want you to be able to make the best decisions for your health and the health of your family members.
For the moment, we strongly encourage people to get vaccinated with either Moderna or Pfizer. Close to 200 million doses of these vaccines have been administered nationwide with an extraordinary safety and effectiveness record. We continue to see >100 new infections each week in our county. Currently, there are people ranging in age from their 30’s to 80’s hospitalized in Calvert with COVID complications. The youngest is in the ICU. None of these people had been vaccinated. Please take care and once we have more information on the J&J vaccine, we will let you know.
COVID Vaccine Update- Johnson & Johnson
The FDA has placed a hold on Johnson & Johnson COVID vaccinations. The FDA is investigating rare blood clots (less than 1 in 1,000,000 people) associated with this one particular vaccine. The blood clots have been seen within 2 weeks of vaccine administration. Blood clots have not been seen with the Moderna or Pfizer vaccines. At this point, the Calvert County health department will only vaccinate people with Moderna and Pfizer vaccines until the FDA concludes its investigation of Johnson & Johnson.
The Moderna and Pfizer vaccines were developed using a completely different technology than the Johnson & Johnson vaccine. 200 million doses of Moderna and Pfizer vaccines have been administered in the U.S. without any safety concerns.
The Calvert County Health Department strongly encourages people to get vaccinated. We continue to see high rates of COVID spread in our county along with hospitalizations and deaths from the virus. Currently, those hospitalized in Calvert include people in their 40’s, 50’s, 60’s, 70’s, and 80’s. Recent deaths have included people who range in age from their early 40’s to their 80’s. During the past month, close to 100 Marylanders have died each week due to COVID infections. Among those who have been vaccinated, we have not seen any hospitalizations or deaths.
For those who have recently received a Johnson & Johnson vaccine, the risk to your health is extremely low. Please keep in mind that the blood clots have occurred in less than 1 in one million people who received a dose, and it is not clear that the clots were a direct result of the vaccine. This type of clot, called cerebral venous sinus thrombosis, occurs in approximately 1 in 200,000 Americans each year. Symptoms include severe headaches that are generally accompanied by vision changes, problems with speech, and a sudden onset of muscle weakness in one area of the body. These are also symptoms of a stroke. Anyone with these symptoms should immediately seek medical care.
We will update our website as more information becomes available.
Variants, Vaccines, and a Light at the End of the Tunnel
25,401 Calvert residents have stepped up to receive COVID vaccinations. That’s 35% of the adult population of our county (27.5% of the population when you include children and teens). With vaccine supplies expected to increase over the next few weeks, it’s possible that everyone 16 and over will be able to get vaccinated by the early June. All three of the currently available vaccines have proven effective and safe. Not only has every major medical association in the U.S. strongly recommended vaccination, but I can say without hesitancy that your doctor does too.
A recent study from the University of Texas Medical Center looked at infection rates in close to 25,000 healthcare workers. There were approximately 8,000 people in each of three groups. The first had chosen not to be vaccinated. The second had received their first dose, but hadn’t completed their final dose. The third was completely vaccinated. During the study period, the number of people diagnosed with infections were 234 in the unvaccinated group, 112 in the partially vaccinated, and 4 in the fully vaccinated group. Studies at other settings across the U.S. have also shown stellar protection from vaccination.
Half of the entire population of Israel have completed their COVID vaccination series. Evidence has shown 97% protection against infection that causes people to feel sick, and 93% protection against any infection, even asymptomatic infection. That means that 93% of vaccinated people have no personal risk from COVID and pose no risk to those around them. That is critically important. We all come in contact people who are immunocompromised, even if we aren’t always aware that someone at work, church, or at the restaurant table next to us has a medical condition that leaves them at greater risk of complications from COVID.
For people who are significantly immunocompromised, it’s extremely important for them to get vaccinated, but it’s likely that the vaccine will not be as completely protective for them as for people with well-functioning immune systems. That’s why we all play a role in protecting our family members and neighbors.
There has been discussion of which vaccine is the best. The quick answer is that they have all proven to be close to 100% protective against hospitalization and death. The Johnson & Johnson vaccine is a bit less effective in preventing mild-moderate infections, but it carries the convenience of only needing one dose. Both Pfizer and Moderna are 2-dose vaccines, but as the Univ. of Texas and Israeli experiences have shown, are extremely effective at preventing even mild infections. For the moment, people aren’t able to choose which vaccine they receive, but everyone can be reassured that all three will dramatically decrease their personal risk and prevent spread through the community. Speaking of which…
Each of the past 4 weeks, the number of COVID cases in Calvert has climbed, and climbed significantly. Case counts have risen 2 ½-fold since mid-February and hospitalizations have increased. We have also seen higher incidence of infections among younger people, some with serious consequences. Last week, there were 3 people in their 30’s who were admitted to our local hospital due to complications of COVID. There is increasing attention to people of all ages who have long-term health problems, including fatigue, neurological symptoms, pain, and respiratory problems after COVID infections.
Why are infection rates increasing despite vaccinations leaving fewer susceptible people? Two main reasons have emerged. The first are COVID variants and the second are changes in people’s behaviors. In Maryland, two variants have been spreading since mid-February. The UK and California strains are more easily transmitted from person-to-person, and they are both more likely to cause severe disease than the original strain. The good news is that the vaccines have been effective against both of these variants.
It’s understandable that people have grown increasingly frustrated with the social limitations that COVID has brought. It’s been a full year of restrictions on gatherings, changes at work, and limits on travel. Even though a lot of people are rockin’ their masks (I’ve seen some great looks and fashion statements), no one actually likes wearing them. It’s also spring, and everyone is feeling more restless. Please be very aware that as we approach the upcoming holiday weekend, your actions will go a long way to decrease further spread as we give time for more people to get vaccinated. At least for the next week, do your best to avoid situations that may expose you to infection. Continue to wear masks and kindly ask others to do the same. These simple acts will make you less likely to spread the virus to family or friends that you’ll see during the holiday.
This spring is a far cry from last year. Not only do we better understand the virus, but we can see the light at the end of the tunnel. The more people who get vaccinated, and the quicker this happens, the faster we stop widespread transmission and get back to business as usual. There’s also less opportunity for new variants to emerge. Too many things have driven us apart as a society, but one thing we can all agree on is that we’ve had it with COVID. Unfortunately, we can’t work out a deal with the virus. Our clearest path forward is to get vaccinated as soon as each of us has the chance.
For those who are hesitant or skeptical, I encourage you to talk to your personal healthcare provider and not necessarily believe what shows up on your newsfeed or social media account. A vaccination is part of your medical care and you owe it to yourself and your loved ones to make a decision based on advice from a truly trusted source. Your doctor or nurse practitioner has an ethical obligation to advise you based on what’s best for your health and safety. You can’t say the same for any website or media outlet.
I will repeat something written in early January: Seldom do our actions lead to as much potential good, with such small risk, as receiving a vaccination to protect against COVID-19. Nothing else holds as much potential to end the physical, emotional, and social harms that have been inflicted on our community and our country over this past year.
We have a chance to take a major step in restoring normalcy to our lives. We also have a chance to come together as a nation in a common cause of patriotic selflessness. Each of us has a chance to act for the good of our community and our nation.
Once you’ve made the decision to get vaccinated, where can you register? Our health department receives a limited supply of vaccines sent each week, as does the hospital. You can register on the Calvert County Government’s site to be vaccinated either by the health department or the hospital. The website is https://www.calvertcountymd.gov/2821/Vaccine. Some area pharmacies receive weekly vaccine doses. Their locations can be found at the following website https://coronavirus.maryland.gov/pages/vaccine. Each pharmacy has its own registration process. (Yes, this whole process is a bit nuts.) In addition, the previously mentioned website has registration information for the state’s mass vaccination sites at Regency Stadium in Charles County, Six Flags, and elsewhere. Mass vaccination sites receive tens of thousands of doses each week.
State officials have finally started sending small allocations of vaccines to some doctors’ offices, but availability remains very limited. There has been no announcement as to when deliveries to doctors’ offices will be expanded. As much as it would be nice for people to receive a vaccine at their personal physician’s office, it may take months before sufficient supplies are available, so please register for a vaccine as soon as you can at any site accessible to you.
Please make a difference and register as soon as you’re eligible. Currently everyone 60 and older is eligible. Starting tomorrow, March 30th, everyone 16 and over with an underlying health condition or disabilities is eligible. Starting April 13th, all Marylanders 55 and older can register, and on April 27th, everyone 16 and older is eligible. Not everyone will be able to get vaccinated immediately, but the registration lists should move much more quickly as the national supply increases through April and early May.
Religious Congregation Letter Revised 3/12/2021
As of March 12, 2021, Religious Leaders should consider the following guidance in response to the ongoing COVID pandemic. Most of the recommendations from November continue to apply. Although COVID infection rates and fatalities have dropped since their peak earlier in the winter, our current case rates are comparable to those in late November. This past week 135 cases were diagnosed in Calvert County and 8 of our residents died of COVID-related complications in the past 3 weeks. Those 60 and older, younger individuals with chronic health conditions, and members of minority races and ethnicities continue to suffer more severe consequences.
The greatest change since the previous guidance is related to the availability of vaccinations. At this point, just over half of the seniors in Calvert have received at least their first COVID vaccine dose and nearly 30% have completed their vaccination series. Among all residents, only 1 in 9 have completed their vaccinations. This means the vast majority of your parishioners remain susceptible to illness and can spread COVID.
All three of the currently approved vaccines have proven to be extremely effective at preventing serious infection, hospitalization, and death. They have also been very, very safe. It is likely that by mid- to late-April, all seniors will have had the opportunity to receive vaccination. Congregation leaders should encourage their parishioners to get inoculated as soon as the opportunity arises. Vaccination is the most effective way for each person to stay safe at home, work, and in worship with their fellow congregation members.
At this time, not enough people have been fully vaccinated and virus transmission rates are not low enough to safely allow a “return to normal”. Although the Governor has lifted restrictions based on Fire Marshal occupancy codes, social distancing and face coverings should continue to be observed. This is particularly important in any indoor setting, but even outdoors, safety precautions should continue as long as COVID transmission rates remain substantial and vaccination access is limited.
Evidence continues to demonstrate that airborne transmission is the most common route of COVID spread. Droplets can spread 3-6 feet and aerosol particles can travel significantly greater distances, particularly in indoor settings. While we are awaiting the delivery of more vaccine doses, consistent use of face masks over both mouth and nose are extremely important to reduce aerosolization and droplet dispersion. Anyone with respiratory problems that make it impossible to wear a mask should not attend group activities or services until at least 75% of the population has immunity to COVID. Even if such people have been vaccinated, a 95% reduction in infection risk is not 100%.
All changes from earlier guidance are in bold, italic font:
1) Encourage congregants who are at high-risk of COVID complications to continue to worship in their homes (possibly viewing or listening to a live stream or recorded service) if they have not completed their vaccination series. Those who have completed their vaccination series can attend services. However, until there is a more substantial reduction in infection rates, it is very important that everyone wears a proper face covering and social distancing should be practiced by those from different households. People at high-risk include anyone age 60 or older and those with chronic medical conditions including diabetes, long-standing high blood pressure, COPD, kidney disease, sickle cell disease (sickle cell trait is not a high-risk condition), congestive heart failure, a recent history of chemotherapy, and any condition that requires immunosuppressant medications.
2) It is extremely important that word be sent to congregation members that anyone with any illness or anyone with a sick member in their household should not attend service for at least 10 days. Even if a person feels well, they could have contracted COVID from an ill family member and be capable of infecting others. Anyone with travel to areas that put them at higher risk for virus exposure should not attend services for 10-days after return to Calvert. Eating inside restaurants and attending events with large numbers of people are particular concerns.
3) Singing by the congregation or choirs should not take place until vaccination rates are higher and COVID transmission in our community is lower. Once we reach the point when singing does not present a significantly increased risk of virus spread, I will send out a notice. Encouraging congregation members to get vaccinated when their opportunities arise will speed up our collective efforts to return to traditional services. Humming for brief periods may be considered as an alternative. Face masks should be worn at all times. Singing dramatically increases the risk of transmitting COVID. If someone is an asymptomatic carrier of the virus, singing increases the amount of virus they exhale and at least doubles the distance the virus carries through the air. Consideration can be given for soloists to perform if they have completed their vaccination series, but there is still some risk that vaccinated people can spread the virus. Choral singing continues to carry substantial risk of spread. Since vaccination is not 100% effective, having groups of people singing is premature until community transmission rates are lower.
Factors that need to be taken into consideration include the quality of the ventilation system (see #8) and the separation of the soloist from others. Older buildings tend to have poor air circulation and allow aerosolized viruses to linger in the air and accumulate across larger areas of the room. If a soloist performs, she/he should be at least 25-feet from the closest person and wear a face covering. If the service takes place outside, the soloist should ideally be downwind from the congregation.
Although song is such an elemental part of religious tradition, this is one time when it is critically important for us all to modify our established behaviors for the safety of our fellow human beings. As the Good Book teaches, in each of our actions, we must be protective of the most vulnerable.
4) If possible, services should be held outside. This helps dissipate viral particles much more effectively than indoor settings. I realize that the weather in Southern Maryland is not always conducive to outdoor events and some congregations may not have the physical space or equipment to hold services outdoors. If outdoor services are feasible, members of the congregation should be encouraged to bring their own fold-up chairs.
5) Regardless of the setting, members of the congregation should be more than 6 feet apart in each direction. Family members living in the same household do not need to be spaced apart.
The Governor's Orders for attendance at religious services are no longer pegged to Fire Marshall capacity. The critical considerations are: 1) adequately spacing people of different households, 2) have everyone properly wear face coverings, and 3) tell people to stay home if they feel ill or have any known exposure to someone who may have COVID.
6) Keep services as short as you reasonably can. Virus transmission is a result of the proximity and duration of exposure to an infected person. The longer someone is near an infected person, the more likely they are to get sick. Given the potential for severe illness with COVID-19, it is very important to limit the time people spend in group settings.
7) When possible, consider outdoor settings for children’s gatherings. Children’s services or daycare areas should have no more than 15 people in a room, including supervising adults. If the room is small, please adjust the number of occupants accordingly. Children should wash their hands with soap and water(preferable) or apply hand sanitizer before entering the room. Children over the age of two should be encouraged to wear face masks. \
Face masks are mandatory for all children over the age of 5 (this is not new, but considering that it will be months before the vaccines are approved for children, it bears emphasis). Consider a craft day that allows children to design or make their own masks with the help of adult volunteers. There are many online guides to making face masks for COVID prevention.
Instead of grouping strictly by age, please consider assigning children from the same household to the same room. Children should attend the same room with the same adult supervisors from week-to-week. Grouping by household and keeping the same assigned rooms each week will decrease the number of children who are potentially exposed to a carrier of COVID. Space children apart as much as reasonable. Children from the same household may sit or play together. If there are several services in a day, the books, toys, or other materials used should be different for each group of children so virus isn’t transmitted via objects. Common touch surfaces should be thoroughly wiped with disinfectant after each group of children leave the room. Please give at least 15 minutes between groups to allow for cleaning and air circulation. If windows or doors can be opened between groups, please do this.
8) Regardless of how indoor services are conducted, efforts should be made to maximize the flow of fresh air into buildings, improve air circulation, and use the best quality filters that your budget can accommodate. Please consult your HVAC contractor to see what adjustments can be made to your system so that optimal air flow is circulating prior to the start of services and other activities. If windows open, take advantage the fresh air to the extent that the weather permits. Portable HEPA filter units are reasonable in smaller rooms, such as those used for children’s activities, but they are not practical for main congregation halls. Consult Consumer Reports or your HVAC consultant for brands that have proven reliable and effective.
9) Common touch surfaces in bathrooms should be cleaned with a basic disinfectant after each service is completed. Please factor this into the timing of services.
10) Consider taping a weekly message, sermon, or service for those who can't safely attend in-person services. This can be placed ahead of time on a Facebook or other social media outlet. For those without internet access, it could be placed on a phone recording.
11) No physical contact should occur between religious leaders and congregants until higher rates of vaccination have been achieved. COVID-19 is more easily spread than the flu. Physical contact of any kind puts you at risk as well as those in your ministry.
12) Good, basic hygiene should be observed. Ideally, hand sanitizer should be made available at the entrance to members of the congregation or they should be encouraged to wash their hands with soap and water immediately upon entry to the facility. All common touch surfaces should be disinfected prior to each service
13) Finally, families continue to face financial uncertainty due to COVID impacts. Pooling resources to help area foodbanks, holiday gift bags for less-fortunate children, and school supplies would be wonderful. Other suggestions can be forwarded to the Interfaith Council or other congregation-to-congregation channels.
For any questions, please contact me: Laurence.firstname.lastname@example.org or 410 535-5400 x306.