CLEVELAND — Some of the top medical minds in northeast Ohio offered a ‘state of the pandemic’ of sorts for our region. Doctors from the Cleveland Clinic and University Hospitals came together for the update on their hospitals’ fight against COVID-19.

Where Things Stand

The Cleveland Clinic’s Chief of Medical Operations, Robert Wyllie, MD confirmed cases and hospitalizations are back on the decline, after reaching a peak in the Delta surge about one month ago. He said at that peak, we were averaging about 7,200 new patients a day. As of Thursday morning, there were 3,500 new patients. Hospitalizations dropped from 3,700 at the peak to 2,500 this morning. Dr. Wyllie said that’s a 34% drop in hospitalizations. But vaccination rates remain a concern.

“As we look at the total population of the state, at least 55% of the people have received at least one vaccine, and 51% are fully vaccinated,” he said. Those numbers don’t bode well as we head into the winter months. Dr. Wyllie shared concern about people potentially gathering for the holidays. He recommended more Ohioans get vaccinated and take simple precautions when they’re together. The CDC has recommended gathering outdoors when possible. If you gather inside, the agency recommends keeping doors or windows open to increase ventilation.

A New Hope

The President of UH Cleveland Medical Center, Daniel Simon, MD spoke about a new hope coming in the fight against COVID-19: a new treatment option.

“We now have within in our hands, the Tamiflu equivalent for COVID-19,” he said. He was referring to the new oral antiviral from Merck, molnupiravir. Dr. Simon said the 40-pill course would be administered over five days, with patients taking four pills each morning and each evening. The drug was shown to reduce hospitalizations and severe disease by 50% in clinical trials. He added, the trials had zero deaths in the molnupiravir group and 8 deaths in the placebo group. That’s not the only reason to be optimistic.

“It’s only $700 a course, much less than the $3,000 for a monoclonal antibody,” he said. Plus, “there’s no need for IV infusion, so it’s much more convenient. And subgroup analysis from the study showed that it was equally effective against all variants, including Delta variant.” Right now, the Food and Drug Administration is considering mulnupiravir for emergency use authorization.

Vaccinating Our Kids

Director of Pediatric Infection Control at UH Rainbow Babies and Children’s Hospital, Claudia Hoyen, MD discussed the expected pending recommendation of the pediatric Pfizer-BioNTech vaccine for 5-to-11-year-olds. Dr. Hoyen said at the peak of the delta surge, her hospital was seeing 10 times as many pediatric COVID-19 patients as it did during the summer and early fall. She also noted that the CDC has found more than 100 children in this age group have died from the virus.

“I can tell you that is probably almost double what would have died from the flu during that time. So when people say, ‘this is a lot like the flu,’ actually, it’s much more serious," Hoyen said. She pointed out that COVID-19 is now the eighth leading cause of death of children in the United States. Over the coming weeks, she and her team will be keeping a close eye on the long-term side effects of children with both mild and serious illnesses. Those might include multi-system inflammatory syndrome (MIS-C), symptoms like brain fog or persistent cough, and myocarditis.

Myocarditis has been of particular concern among parents after rare cases developed in young Americans who received the COVID-19 mRNA vaccines. Dr. Hoyen said in the 5-11 age group study, there were no cases of myocarditis. That doesn’t mean we won’t see a few rare instances once the vaccine is distributed to the general public. But, she noted, the cases have been extremely rare in other age groups.

“As we vaccinated the 12-to-15-year-olds,” she said, “that group has not had as high an incidence of myocarditis as the people who were 18-to-30, those young men 18-to-30. And so again, it seems this is less of an issue in children.” Still, she said doctors will be keeping a close eye on that risk. Children who have developed myocarditis after being vaccinated have had very mild cases, she said. And this particular risk is much higher for children who contract the COVID-19 virus.

“The incidence of myocarditis in children with the actual COVID virus is about 10-to-100 times higher, depending on the data you’re looking at, than from the vaccine,” she said.

The FDA is expected to meet in the coming days to decide on a panel’s recommendation to approve the pediatric vaccine dose. The CDC makes its recommendation after that. Doses could be ready to administer to the 5-to-11 age group as soon as next week.

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