ACP: Lessons Learned during COVID-19 Pandemic
Rochelle Walensky, MD MPH, Director of the US Centers for Disease Control and Prevention (CDC), was a featured presenter at the recent American College of Physicians Internal Medicine Meeting 2021: Virtual Experience. In her presentation, titled "COVID-19: Lessons Learned," Dr Walensky discussed racial/ethnic inequities in COVID-19 impact, breakthrough infections, what happened with the Johnson & Johnson vaccine, and variants of concern in the US.
The slide show that follows is based on Dr Walensky's presentation and includes links to all of the primary studies that she discusses.
Racial/Ethnic Inequities. Racial/ethnic minority populations have experienced higher rates of COVID-19 incidence, hospitalizations, and mortality. An analysis of over 114 000 COVID-19-associated deaths between May-August 2020 found that 24.2% of deaths were among Hispanic or Latino populations, yet they make up 18% of the total US population; 18% were among Black populations, yet they make up 12% of total US population.
Racial/Ethnic Inequities. A February 2021 NVSS report showed that between 2019 and the first 6 months of 2020, life expectancy decreased by 2.7 years for the non-Hispanic Black population and 1.9 years for the Hispanic population, as compared to 0.8 year for the non-Hispanic White population.
Racial/Ethnic Inequities. Dr Walensky noted that despite CDC efforts to ensure COVID-19 vaccines are getting to communities most at risk, more work is needed. For example, as of April 14, 2021, 9% of the Hispanic population and 8% of the Black population were fully vaccinated vs 68% of non-Hispanic White population. However, Walensky said data from the last 2 weeks is encouraging, with 11% of the Hispanic population and 10% of the Black population fully vaccinated.
COVID-19 Breakthrough Cases. As of April 20, 2021, there were 7157 reports of vaccine breakthrough infections reported among people of all ages eligible for vaccination. While rare, Dr Walensky noted that it is also expected based on the high amount of vaccines administered. The CDC has developed a national COVID-19 vaccine breakthrough database. Local laboratories are encouraged to report cases to state health departments to be included in the database.
J&J Vaccine: What happened?
• COVID-19: 200 hospitalizations per million population; 30 deaths per million population
• CVST after COVID-19: 5-6 cases per million SARS-CoV-2 infections
• Heparin‐induced thrombocytopenia: 25-45 per million population
• CVST: 14.5-28.5 per million population
• CVST + TTS: 0.7-1.6 per million population
Potential Harms of J&J Vaccine. In the week following the pause of the J&J vaccine, there were 7.98 million vaccine doses administered and 15 confirmed TTS cases. Additional potential TTS cases are under review, including potential cases among men.
Variants of Concern in US: B.1.1.7 (United Kingdom) and B.1.351 (South Africa)
Variants of Concern in US: B.1.427/B.1.429 (California) and P.1 (Brazil)
