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Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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10:15 AM
June 15th, 2020

COVID-19 Vaccines on the Horizon

COVID-19 Vaccines on the Horizon

June 15, 2020

 

 

 

Is the day at hand when COVID-19 will be a preventable disease? Is a vaccine possible? Is it achievable in the foreseeable future? We endeavor here to shed some light on these questions.

 

 

Vaccine Testing

 

New vaccines pass through several phases. Preclinical testing consists in inoculating animals with the vaccine to determine if it produces an immune response. Phase 1 Safety trials consist of using on a small number of people to determine safety and dosage and to confirm stimulation of immunity. Phase 2 Expandedtrials involve hundreds of people divided into different groups to determine if the vaccine acts differentially. Phase 3 Efficacy trials involve thousands of people to compare the vaccine to an inactive placebo. Approvalis granted by regulators based on the vaccine’s performance in these trials. However, Emergency Use Authorization may be granted before final approval in extenuating circumstances. [1]

 

To reduce delays, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has indicated that manufacturers will begin producing COVID-19 vaccine in anticipation of approval so that if a product gets the okay for usage, distribution can begin quickly. [2]

 

 

Number of Vaccines

 

Scientists worldwide are working on vaccine development. There may currently be more than 140 COVID-10 vaccines in progress, according to the World Health Organization. Here are some of the vaccine candidates farthest along in their development. [1]

 

mRNA-1273

 

This is a promising candidate being developed by Moderna. The Phase 1 trial involved 45 people divided into groups that received doses of 25, 100, and 250 micrograms. According to Moderna, all subjects developed antibodies, but the eight who received 25 or 100 micrograms developed more COVID-19 antibodies than people who actually recovered from the disease. The data has not been peer-reviewed or journal-published. As of this writing, this vaccine is in Phase 2 trials. [3]

 

AZD1222

 

The AZD1222 vaccine was developed by Oxford University’s Jenner Institute, for production by Astra Zeneca. It is based on a chimpanzee adenovirus. It would be administered in one dose and would not replicate. The vaccine is reported to have performed well in a Phase 1 trial with 320 people. It is currently in Phase 2/3 trials in England and Brazil. [4]

 

Ad5-nCoV

 

Ad5-nCoV vaccine is the product of a collaboration between a Chinese biologics company and Canada’s Precision NanoSystems. It utilizes a platform the Chinese company developed for its vaccine against Ebola. When the vaccine’s Phase 1 trial on 108 subjects was published in The Lancet, it became the first clinical study of a vaccine to be published in a peer-reviewed journal. Ad5-nCoV was found to be tolerable and immunogenic at 28 days post-vaccination and is now in Phase 2. [5]

 

NVX‑CoV2373

 

NVX‑CoV2373 is a vaccine developed by Novavax using its proprietary nanoparticle technology carrying fragments of corona virus proteins along with its proprietary adjuvant Matrix-MTM, which stimulates higher levels of neutralizing antibodies. Phase 1 has enrolled 130 healthy subjects at two sites in Australia to assess doses of 5 and 25 micrograms, with and without Matrix-M. It is currently in Phase 1/2. [6]

 

CoronaVac 

 

CoronaVac is an inactivated virus vaccine created by the Chinese company Sinovac Biotech. Phase 1 testing has included 143 volunteers while Phase 2 has had 600 volunteers. The Phase 2 trial has shown neutralizing antibodies produced 14 days after vaccination and a seroconversion rate of 90%. Phase 3 clinical studies are projected in collaboration with Instituto Butantan in Brazil. [7]

 

Sinopharm Vaccine

 

The state-owned Chinese company Sinopharm has produced an inactivated virus vaccine initially tested in 96 subjects in a randomized, double-blind, placebo-controlled trial during which it reportedly evidenced a good safety profile. The current Phase 2 trial focuses on the vaccination procedure. [8]

 

These last two vaccines, CoronaVac and Sinopharm Vaccine, are based on an existing whole-virus technology. The advantage is that, as such, they are more familiar to produce. The disadvantage is that they may require multiple doses or act more slowly to produce immunity.

 

It is important that one or more of these vaccines succeed in order to produce individual as well as herd immunity to end the threat of COVID-19. Hopefully it will soon join polio, smallpox, and other diseases that have been eradicated.

 

Thomas Falasca, DO

 

 

 

Sources

 

[1] Coronavirus Vaccine Tracker, New York Times,

By Jonathan Corum and Carl Zimmer June 10, 2020

 

[2] Medscape Medical News

Fauci: US Poised to Produce a COVID-19 Vaccine

Gregory Twachtman

May 12, 2020

 

[3] Medscape, First COVID-19 Vaccine Tested on Humans Shows Early Promise,

Ralph Ellis May 18, 2020

 

[4] AstraZeneca advances response to global COVID-19 challenge as it receives first commitments for Oxford’s potential new vaccine, Adrian Kemp 

PUBLISHED21 May 202

 

[5] CanSino Publishes Phase I Data for COVID-19 Vaccine Candidate, Moves into Phase II

Published: May 22, 2020 By Alex Keown

 

[6] Novavax Initiates Phase 1/2 Clinical Trial of COVID-19 Vaccine, Novavax Press release, GAITHERSBURG, Md., May 25, 2020

 

[7] Sinovac Announces Positive Preliminary Results of Phase I/II Clinical Trials for Inactivated Vaccine Candidate Against COVID-19, June 13, 2020 01:45 PM Eastern Daylight Time

 

[8] https://www.clinicaltrialsarena.com/news/china-third-covid-19-vaccine-trial/

27 APRIL 2020 NEWS, China approves clinical trials of third Covid-19 vaccine candidate

 

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Important Facts about Face Masks and COVID

Face Masks: What You Need to Know ...See More

Important Facts about Face Masks and COVID

 

 

 

The face mask is one of the best defenses we have against the COVID virus. All face masks, however, are not alike. Here we explore the history of medical masks and discriminate the most effective from the less effective.

 

History and Purpose of Surgical Masks

 

In the 1860s, Louis Pasteur proposed that microorganisms caused spoiling of wine, beer, and milk and invented the process of pasteurization to avoid the “diseases” of wine.1 He believed that microorganisms also caused animal and human disease. Shortly thereafter, Joseph Lister2 began using carbolic acid to inactivate germs on surgical wounds and instruments.

 

Finally, in 1897, after learning from bacteriologist Carl Flügge that respiratory droplets carry culturable bacteria, Polish surgeon Johann Mikulicz began wearing a mask in the operating room. French surgeon Paul Berger, began doing likewise.3

 

Early surgeons knew that a majority of the respiratory droplets were expelled through talking. Consequently, they made it routine to avoid talking in the operating room, instead using hand gestures to request instruments. This was quite prescient. Less prescient was that they ignored the respiratory droplets potentially coming from the nose and consequently often wore the mask only covering the mouth.

 

The year 1919 saw the patenting of reusable cotton surgical masks. Then, in the 1960s, single use, disposable surgical masks began replacing the cotton varieties.

 

In the early 1900s, masks were considered important only in protecting the surgical patient from the exhalations of physicians and nurses. This changed with the Manchurian plague of 1910 and the influenza pandemic of 1918, which saw the mask as protecting physicians, nurses, and civilians from the exhalations of potentially infected patients.3

 

Types of Masks

 

The two most popular masks are the “surgical mask” and the N95 mask.

 

The “surgical mask” is the familiar rectangular mask with horizontal pleats, white inside and colored (usually green or blue) outside worn by securing an upper and a lower pair of ties or ear loops. The white and colored layers sandwich a middle layer of microfibers that obstruct particles mechanically and/or hold them with an electrostatic charge.4

 

 On the other hand, the N95 mask or N95 respirator is a roughly cup-shaped device, sometimes with a vertical fold, and of the same color (usually white) both inside and outside, with a middle layer of microfibers that obstruct particles mechanically and/or hold them by an electrostatic charge.

Differences between the Two Masks

 

  • Layers
  •      -- The surgical mask has different inner and outer layers. The outer layer is fluid resistant as additional protectionfrom infected droplets contacting the mucous membranes of the nose or mouth of the wearer.
  •      -- In the N95 mask, the same materials compose the inside and outside layers.

 

Fit

  •      -- The surgical mask does not conform well to the face and permits unfiltered air to enter and exit around the mask. This is more pronounced on inhalation when the mask tends to collapse on the wearer’s face.
  •      -- The N95 mask has improved conformance to the features of the face and improved stability to reduce air flow in and out around the mask.

 

Original Purpose

  •      -- The surgical mask was intended to protect the patient from the surgeon’s exhalations and the surgeon from irrigating fluid splashes during surgery.
  •      -- The N95 mask descends from masks intended to protect workers from particle inhalation.

 

Filtration

  •      -- Surgical masks differ in filtration but most effectively filter particles of 3.0 micron size and some effectively filter particles of 0.1 micron size.
  •      -- N95 masks filter 95% of particles size 0.3 microns; this is the origin of their name N95. For comparison, the COVID-19 virus has a reported size of 0.05 to 0.2 microns.5

 

Effectiveness

  •      -- N95 masks are considered more effective than surgical masks in part because their shape reduces leaks around the mask.
  • For this reason, the N95 masks are recommended for healthcare workers and prioritized to them by the World Health Organization (WHO)6 and the Centers for Disease Control (CDC)7.

 

Correct Wearing of Masks

     -- The World Health Organization has produced this excellent infographic on the correct wearing of masks.8

 

Other Face Coverings

 

Although it would seem that any face covering is better than no face covering, this is seldom the choice, as surgical masks, if not N95 masks, are usually readily available and they are certainly the most efficacious.

 

Valved N95 Type Masks

These are distinctly inferior or surgical or N95 masks. The valve closes on inhalation so that inflowing air is filtered. It then opens on exhalation. This is appealing as it makes exhalation easier and reduces moisture and heat buildup inside the mask. However, it fails to protect others from the wearer’s exhalations. The mask may also generate a false sense of effectiveness since it looks like an N95 mask.

 

Homemade Masks

Homemade masks of cotton or T-shirt material vary in effectiveness directly as the number of layers of cotton in the mask and inversely as the number of times the mask has been laundered. Regardless, however, the best homemade masks are inferior to the surgical or N95 masks.9

 

Neck Gaiters

Neck gaiters fared even worse in effectiveness experiments.9 Of course, the stretchy construction makes for ease in pulling up or down, but it also creates more permeability in the fabric. Certainly, being able to see through the face covering when it is held up to the light is an indication of the covering’s ineffectiveness.

 

Bandanas

At the bottom of the effectiveness list are bandanas according to experiment.9

These permit easy escape of virus-laden droplets both through and out the bottom of the covering.

 

Face Shield 

Th transparent face shield was never designed to be respiratory protection for the wearer

or proximate persons. The wide openings at the bottom and sides permit broad inflow and

outflow of unfiltered air. However, since virus particles gain access to the body through th

mucous membranes of the eyes as well as those of the nose and mouth, the face shield

was designed to protect the eyes from splashes containing microbiological contaminants.

 

 

Conclusion

 

Until widespread inoculation with COVID-19 vaccine can be implemented, surgical and N95 masks are some of the best weapons against the corona virus. To achieve this goal, they must be chosen over less effective options and used correctly, certainly until we can view this epidemic as passed.

 

Thomas Falasca, DO FACA FACPM

 

References

 

1 Louis Pasteur. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Louis_Pasteur 

2 Joseph Lister. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Joseph_Lister

Strasser, B. J., & Schlich, T. (2020, May 22). A history of the medical mask and the rise of throwaway ... Retrieved December 3, 2020, from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31207-1.pdf

4 Surgical mask. (2020, November 28). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Surgical_mask

5 Severe acute respiratory syndrome coronavirus 2. (2020, December 04). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

6 Mask use in the context of COVID-19: Interim guidance, 1 December 2020. (2020, December 01). Retrieved December 5, 2020, from https://apps.who.int/iris/handle/10665/337199

7 Centers for Disease Control (CDC). (2020, August 08). Personal Protective Equipment: Questions and Answers. Retrieved December 5, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

8 World Health Organization (WHO). (2020, December 01). When and how to use masks. Retrieved December 5, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

9 Dockrill, P. (2020, August 10). Simple New Experiment Reveals Which Face Masks Are Best at Blocking Droplets. Retrieved December 5, 2020, from https://www.sciencealert.com/simple-low-cost-experiment-reveals-which-face-masks-are-best-at-blocking-droplets

 

Hand Sanitizing in the Time of COVID

Hand Sanitizing and Washing in the Time of COVID and Flu ...See More

Hand Sanitizing in the Time of COVID

 

Hand Sanitizing and Washing in the Time of COVID and Flu

 

Now, in the time of COVID and flu, hand sanitizing and washing is more important than ever. These simple measures, done frequently and effectively, help prevent COVID and flu as well as many other infections. However, their use is not so intuitive as imagined. Let’s examine the why, when, and how.

 

Why Sanitize or Wash?

 

Many infectious diseases have no reliable vaccination or treatment. Even for treatable infectious diseases, the better way to deal with them is not to have them. Prevention is the purpose of hand sanitizing and washing.

 

People who are infectious, whether or not they are sick, understandably contaminate their hands with the germs. Then our hands touch their hands or surfaces they have touched. We then touch our hands to our faces, in fact, according to some studies, an average of 20 times per hour. But the mucous membranes of eyes, nose, and mouth provide easy access to the body for germs, especially for viruses because of virus’ small size. We should keep our hands away from our faces as much as possible, even when the hands appear clean. However, still we touch, mostly inadvertently. Doing so, we become infected.

 

Sanitizing Hands or Washing Them

 

Hand sanitizer is a potent hygienic weapon during the frequent circumstances when hand washing is not available. While hand washing removes germs and harmful chemicals, hand sanitizers inactivate a large number of the germs without removing. They accomplish this because sanitizers containing at least 60% ethyl alcohol denature the proteins of bacteria and viruses in only about 15 seconds.

 

Hand sanitizers are less effective when hands are visibly dirty or greasy as the dirt can protect the germs from complete contact with the sanitizer. Of course, it is senseless to use sanitizer to smear dirt more widely when removal by washing is an option.

 

Children should use hand sanitizers under adult supervision as swallowing hand sanitizers can cause alcohol poisoning. Children may be more likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children.

 

Disposable Gloves

 

Disposable gloves may create a false sense of security. Certainly, they shield the skin of the hands from contamination, but the gloves become contaminated and must either be treated with hand sanitizer or disposed of. Further, in removing the contaminated gloves for disposal, the previously clean hands may become contaminated.

 

When to Sanitize or Wash Hands

 

The most obvious time to sanitize or wash is after contact such as

     • After touching high-hand-contact surfaces such as public touch screens, door handles, elevator buttons,      handrails, and poles or handles on public transportation.
     • Touching the outside of a face mask.
     • Touching money.
     - Tying shoes.
     - Coughing, sneezing, or blowing the nose.
     - Touching a sick person,
     - Touching an animal, animal feed, animal waste, or garbage.
     - Using the bathroom or changing diapers.
     - Treating a cut or wound

 

Important also is sanitizing or washing before

  •      - Touching face.
  •      - Eating, drinking, or tooth brushing.
  •      - Preparing food.
  •      - Touching a sick person.
  •      - Treating a cut or wound.
  •      - Finally, stores or venues may require sanitizer use before entering to reduce contamination on their merchandise or facilities.

 

How to Sanitize Hands

 

Using a small hand sanitizer is easy and convenient.

  •         - Choose a sanitizer with at least 60% ethyl alcohol.
  •      - Keep the sanitizer easily accessible. This negates the temptation to skip it. It also avoids germs on hands from contaminating the insides of pockets and handbags while rooting around for the sanitizer.
  •      - Use only enough sanitizer to contact germs on all hand surfaces. The idea is to kill germs by contact with the sanitizer, not to wash germs away.
  •      - Spread the sanitizer to contact all surfaces of the hands and fingers, including under the fingernails and the outside of the sanitizer bottle.
  •      - The sanitizer does its work within 15 seconds of contact.
  •      - Here is the illustration.

Hand Sanitizer

 

 

How to Wash Hands

 

Hand washing may not be always intuitive.  

     - Use plenty of warm, running water and sufficient soap. At faucet temperature, the warmth of the water does not kill germs, However, warmer water and soap improves the dissolution of any dirt protecting the germs and reduces the germs’ adherence to the skin.

     -  Rub hands together with sufficient pressure. The idea is not to kill germs, but to remove them. Sufficient pressure and a sufficient volume of water improve the liklihood of dislodging germs and carrying them away.

     - Wash front and back of hands, all fingers, between the fingers, and under the nails for at least 20 seconds. Twenty seconds is about the time it takes to hum two repetitions of the Happy Birthday Song.

     - Avoid drying hands with cloth towels since this may transfer other people’s germs. Better are electric hand dryers as found in public rest rooms. Be sure to press the dryer’s on-off switch with your elbow. Finally, paper towels, although the least ecological hand-drying option, are the most hygienic. Additionally, use a dry paper towel to turn off the faucet and to touch the door handle when leaving a public rest room. If there is no used-paper-towel depository by the door, let the paper drop to the floor, the public rest room maintainers will get the message to provide a depository.

 

Conclusion

 

Now, in the time of COVID and flu, hand sanitizing and washing is more important than ever. Above are the why, when, and how. Remaining is only the do … and the do is up to me and you!

 

Thomas Falasca, DO

 

Thomas Falasca, DO

 

 

 

 

 

 

 

 

COVID-19 Vaccines on the Horizon

Learn about the COVID-19 Vaccines on the Hori ...See More

COVID-19 Vaccines on the Horizon

COVID-19 Vaccines on the Horizon

June 15, 2020

 

 

 

Is the day at hand when COVID-19 will be a preventable disease? Is a vaccine possible? Is it achievable in the foreseeable future? We endeavor here to shed some light on these questions.

 

 

Vaccine Testing

 

New vaccines pass through several phases. Preclinical testing consists in inoculating animals with the vaccine to determine if it produces an immune response. Phase 1 Safety trials consist of using on a small number of people to determine safety and dosage and to confirm stimulation of immunity. Phase 2 Expandedtrials involve hundreds of people divided into different groups to determine if the vaccine acts differentially. Phase 3 Efficacy trials involve thousands of people to compare the vaccine to an inactive placebo. Approvalis granted by regulators based on the vaccine’s performance in these trials. However, Emergency Use Authorization may be granted before final approval in extenuating circumstances. [1]

 

To reduce delays, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has indicated that manufacturers will begin producing COVID-19 vaccine in anticipation of approval so that if a product gets the okay for usage, distribution can begin quickly. [2]

 

 

Number of Vaccines

 

Scientists worldwide are working on vaccine development. There may currently be more than 140 COVID-10 vaccines in progress, according to the World Health Organization. Here are some of the vaccine candidates farthest along in their development. [1]

 

mRNA-1273

 

This is a promising candidate being developed by Moderna. The Phase 1 trial involved 45 people divided into groups that received doses of 25, 100, and 250 micrograms. According to Moderna, all subjects developed antibodies, but the eight who received 25 or 100 micrograms developed more COVID-19 antibodies than people who actually recovered from the disease. The data has not been peer-reviewed or journal-published. As of this writing, this vaccine is in Phase 2 trials. [3]

 

AZD1222

 

The AZD1222 vaccine was developed by Oxford University’s Jenner Institute, for production by Astra Zeneca. It is based on a chimpanzee adenovirus. It would be administered in one dose and would not replicate. The vaccine is reported to have performed well in a Phase 1 trial with 320 people. It is currently in Phase 2/3 trials in England and Brazil. [4]

 

Ad5-nCoV

 

Ad5-nCoV vaccine is the product of a collaboration between a Chinese biologics company and Canada’s Precision NanoSystems. It utilizes a platform the Chinese company developed for its vaccine against Ebola. When the vaccine’s Phase 1 trial on 108 subjects was published in The Lancet, it became the first clinical study of a vaccine to be published in a peer-reviewed journal. Ad5-nCoV was found to be tolerable and immunogenic at 28 days post-vaccination and is now in Phase 2. [5]

 

NVX‑CoV2373

 

NVX‑CoV2373 is a vaccine developed by Novavax using its proprietary nanoparticle technology carrying fragments of corona virus proteins along with its proprietary adjuvant Matrix-MTM, which stimulates higher levels of neutralizing antibodies. Phase 1 has enrolled 130 healthy subjects at two sites in Australia to assess doses of 5 and 25 micrograms, with and without Matrix-M. It is currently in Phase 1/2. [6]

 

CoronaVac 

 

CoronaVac is an inactivated virus vaccine created by the Chinese company Sinovac Biotech. Phase 1 testing has included 143 volunteers while Phase 2 has had 600 volunteers. The Phase 2 trial has shown neutralizing antibodies produced 14 days after vaccination and a seroconversion rate of 90%. Phase 3 clinical studies are projected in collaboration with Instituto Butantan in Brazil. [7]

 

Sinopharm Vaccine

 

The state-owned Chinese company Sinopharm has produced an inactivated virus vaccine initially tested in 96 subjects in a randomized, double-blind, placebo-controlled trial during which it reportedly evidenced a good safety profile. The current Phase 2 trial focuses on the vaccination procedure. [8]

 

These last two vaccines, CoronaVac and Sinopharm Vaccine, are based on an existing whole-virus technology. The advantage is that, as such, they are more familiar to produce. The disadvantage is that they may require multiple doses or act more slowly to produce immunity.

 

It is important that one or more of these vaccines succeed in order to produce individual as well as herd immunity to end the threat of COVID-19. Hopefully it will soon join polio, smallpox, and other diseases that have been eradicated.

 

Thomas Falasca, DO

 

 

 

Sources

 

[1] Coronavirus Vaccine Tracker, New York Times,

By Jonathan Corum and Carl Zimmer June 10, 2020

 

[2] Medscape Medical News

Fauci: US Poised to Produce a COVID-19 Vaccine

Gregory Twachtman

May 12, 2020

 

[3] Medscape, First COVID-19 Vaccine Tested on Humans Shows Early Promise,

Ralph Ellis May 18, 2020

 

[4] AstraZeneca advances response to global COVID-19 challenge as it receives first commitments for Oxford’s potential new vaccine, Adrian Kemp 

PUBLISHED21 May 202

 

[5] CanSino Publishes Phase I Data for COVID-19 Vaccine Candidate, Moves into Phase II

Published: May 22, 2020 By Alex Keown

 

[6] Novavax Initiates Phase 1/2 Clinical Trial of COVID-19 Vaccine, Novavax Press release, GAITHERSBURG, Md., May 25, 2020

 

[7] Sinovac Announces Positive Preliminary Results of Phase I/II Clinical Trials for Inactivated Vaccine Candidate Against COVID-19, June 13, 2020 01:45 PM Eastern Daylight Time

 

[8] https://www.clinicaltrialsarena.com/news/china-third-covid-19-vaccine-trial/

27 APRIL 2020 NEWS, China approves clinical trials of third Covid-19 vaccine candidate

 

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