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   Dr. Bralow’s Bulletin
September 10th, 2021
Edition #132 – est 3/2020

This week’s Bulletin discusses Influenza (the Flu), along with the latest updates on COVID-19:


The flu (or influenza) is a highly contagious viral infection of the respiratory tract that can cause severe illness and life-threatening complications (including pneumonia). It affects people of all ages. The flu is spread by contact with fluids from coughs and sneezes that contain the flu virus. The most common symptoms of the flu are:

  • sudden appearance of a high fever (38°C or more)
  • a dry cough
  • body aches (especially in the head, lower back and legs)
  • feeling extremely weak and tired (and not wanting to get out of bed).
  • chills
  • aching behind the eyes
  • loss of appetite
  • sore throat
  • runny or stuffy nose.

Both the flu and COVID-19 can have the symptoms listed above. But COVID-19 can also cause serious breathing problems, and loss of taste or smell — which are not usual with the flu. Another difference is that COVID-19 symptoms may take up to 14 days to appear, compared with 1 to 4 days with the flu. 

Symptoms of the flu hit very quickly and may last several weeks. A bout of the flu typically follows this pattern:

  • Days 1–3: Sudden appearance of fever, headache, muscle pain and weakness, dry cough, sore throat and sometimes a stuffy nose.
  • Day 4: Fever and muscle aches decrease. Hoarse, dry or sore throat, cough and possible mild chest discomfort become more noticeable. You may feel tired or flat.
  • Day 8: Symptoms decrease. Cough and tiredness may last one to two weeks or more.

For most people, the flu resolves on its own. But sometimes, influenza and its complications can be deadly. People at higher risk of developing flu complications include:

  • Young children under age 5, and especially those under 6 months
  • Adults older than age 65 
  • People who are very obese, with a body mass index (BMI) of 40 or higher
  • Residents of nursing homes and other long-term care facilities
  • Pregnant women and women up to two weeks after giving birth
  • People with weakened immune systems
  • Native Americans
  • People who have chronic illnesses, such as asthma, heart disease, kidney disease, liver disease and diabetes

Influenza viruses travel through the air in droplets when someone with the infection coughs, sneezes or talks. You can inhale the droplets directly, or you can pick up the germs from an object — such as a telephone or computer keyboard — and then transfer them to your eyes, nose or mouth. People with the virus are likely contagious from about a day before symptoms appear until about five days after they start. 

Each year’s seasonal flu vaccine provides protection from the three or four influenza viruses that are expected to be the most common during that year’s flu season. There are four different types of influenza viruses: A, B, C, and D.

  • Influenza A and B are responsible for seasonal flu and flu epidemics in humans. Influenza A is most likely to cause pandemics. Both influenza A and B are included in the annual flu vaccine.
  • Influenza C causes a very mild illness in humans. It does not cause pandemics. 
  • Influenza D is a virus that infects cattle. It does not cause disease in humans.

The flu season is different every year because the viruses that cause it are different every year. Flu viruses have a protein coat around them. The influenza A virus — and, to a lesser extent, the influenza B virus — regularly updates its protein coat. That means that every year, flu viruses behave a little differently. The changes in the protein coat affect how contagious the flu viruses are and how severe the flu illness is.  Every year at the end of the flu season, experts worldwide try to predict what the following year’s flu virus strains will be. The next season’s flu vaccine is made based on these predictions. Some years, the match between what is predicted and what actually happens is more or less better than others.

You can get sick with the flu at any time of the year, but the flu is most common in the fall and winter months. Flu cases tend to start ramping up in October and then peak between December and February. Sometimes, the flu season peaks a second time later in the year, as it did in 2019, and sometimes, the season can extend well into the spring. The exact timing of the flu season varies year by year, depending on which strains of the virus are circulating and how strong the vaccine is.

The Centers for Disease Control and Prevention (CDC) recommends people get their flu shot by the end of October. It takes 2 weeks for the immune system to fully respond to a vaccine. Early vaccination (July-Mid-September) is meant for children and individuals who need two flu shots in a season. For people who only need one vaccine, early vaccination is not recommended because the immune response will decrease over time and may not last to the end of the flu season

The 2017-18 season was the first season to be classified as a high severity across all age groups and the percentage of deaths attributed to pneumonia was at or above the epidemic threshold for 16 consecutive weeks. The overall vaccine effectiveness (VE) of the 2017-2018 flu vaccine against both influenza A and B viruses is estimated to be 40%. This means the flu vaccine reduced a person’s overall risk of having to seek medical care at a doctor’s office for flu illness by 40%. Protection by virus type and subtype was: 25% against A (strain H3N2 ), 65% against A (strain H1N1) and 49% against influenza B viruses. 

The flu shot can protect you from getting sick. And if you’ve had the flu shot and do still get the flu, the vaccine can help you have a milder case. It may even protect you from ending up in the hospital or ICU (intensive care unit). Here you’ll find information about what the flu shot is and how it works.


  • Philadelphia is starting to see a drop in new COVID-19 cases. In terms of vaccinations, 67% of adults in Philadelphia are fully vaccinated and nearly 82% of adults have received at least one dose of a vaccine. According to data gathered by the Action News Data Journalism team, hospitalized COVID-19 patients in Philadelphia are using:
  1. 17% of adult ICU beds
  2. 20% of pediatric beds
  3. 13% of pediatric ICU beds
  4. 12% of medical/surgical beds
  • School districts across the Delaware Valley are scrambling due to a shortage of bus drivers. The shortage predates the COVID-19 pandemic, but school closures and layoffs didn’t help in 2020. Philly Transportation LLC, contracted to transport thousands of students, is offering signing bonuses, medical and 401K benefits. The New Jersey School Bus Contractors Association has seen a steep drop off, estimating 20% of drivers have not returned after layoffs because of COVID closures. “This week, the extended unemployment benefits have expired and it may be a little push for somebody who would like to return to the workforce,” said Evie Wills, an administrator with the New Jersey School Bus Contractors Association. Some school districts like Philadelphia, are offering families who opt out of transportation services up to $150 a month.


  • Stacey Kallem, director of the maternal, child, and family health division for the Philadelphia health department, said vaccination is safe during pregnancy and can even protect babies because antibodies can cross the placenta. More than 150,000 people nationwide have gotten vaccinated while pregnant, Kallem said, and in pregnant patients followed closely there have been no safety concerns for mothers or babies.


  • The health department is working with the School District of Philadelphia to have more testing for children in activities where masks can’t be worn, such as choir or playing musical instruments, and in classrooms where children cannot wear masks due to disabilities. The school district will be doing that testing, Bettigole said, and officials are also in discussions with private schools to put similar procedures in place. ”We’ve got over 100,000 kids in school so we would expect to see some cases,” she said. “We are not seeing major outbreaks at this stage but this is all going to be something that has to be managed in order to keep kids in school and learning.”


  • Two University of Pennsylvania scientists have won a $3 million prize for their work on messenger RNA (mRNA), the genetic molecule that is the basis for the COVID-19 vaccines made by Moderna and Pfizer-BioNTech. The honor for Katalin Karikó and Drew Weissman was announced Thursday morning for achievement in science and math. The annual awards, now in their 10th year, are funded by an international group of tech-industry leaders, including Facebook cofounder Mark Zuckerberg. Karikó started studying mRNA in the mid-1990s, when most scientists considered it a dead end. Starting in 2005, she and Weissman made a series of discoveries that would enable mRNA to be used as a delivery vehicle for vaccines. The versatile molecules also are being studied as treatments for cancer and numerous other diseases.


  • More and more institutions in the area are requiring patrons to show their vaccination card (normally either the physical copy or a photo of it will do) to access their services. 
  1. For more information about restaurants requiring proof of vaccination, click here. 
  2. For more information about performance venues and music festivals requiring proof of vaccination, click here.
  3. For more information about gyms requiring proof of vaccination, click here.
  4. The City of Philadelphia requires that all students, staff, and faculty at universities within the city limits are fully vaccinated against COVID-19 by October 15, 2021. This goes for students and staff at the University of Pennsylvania, Drexel University, Temple University, LaSalle University, Philadelphia Community College, Lincoln University’s West Philly campus, and Thomas Jefferson University.


  • As of Sunday, 6.11 million people have been partially vaccinated in Pennsylvania, and 5.08 million people have been fully vaccinated. Totals do not include Philadelphia, which has a separate vaccination program, or the 373,000 total doses administered by CVS.
  • Yesterday, President Joe Biden announced sweeping new federal vaccine requirements affecting as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant. The expansive rules mandate that:
  1. Employers with more than 100 workers must require their workers to be vaccinated or test for the virus weekly, affecting about 80 million Americans. 
  2. Health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated. This is about 17 million people.
  3. Biden is also signing an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government – with no option to test out. That covers several million more workers.
  4. Biden moved to double federal fines for airline passengers who refuse to wear masks on flights or to maintain face covering requirements on federal property
  5. Biden will call for large entertainment venues and arenas to require vaccinations or proof of a negative test for entry. 
  6. The Centers for Medicare & Medicaid Services will extend a vaccination requirement issued earlier this summer for nursing home staff to now include other healthcare settings –  hospitals, home-health agencies and dialysis centers.
  • Anthony Fauci, the nation’s leading infectious disease expert, said children under the age of 12 might be able to get vaccinated against COVID-19 by November. Both Pfizer and Moderna are doing vaccine trials on children, and both companies will likely submit their findings to the FDA for what’s known as an emergency use authorization. “The Pfizer data will probably be ready sometime at the end of September, the beginning of October,” Fauci said during a New York Times live event on Thursday. “And the Moderna data a bit later, the end of October or the beginning of November.” Fauci said if the FDA deems this an emergency situation for children, it could approve the vaccines for children as soon as a few weeks after the data was submitted.
  • As of Tuesday, 75% of U.S. adults have received at least one dose of a COVID vaccine, and 64.3% are fully vaccinated, according to the latest CDC data.


  • Polls have repeatedly highlighted vaccine hesitancy among Republicans, but data from the CDC shows only 90% of the Black population and 84% of the Hispanic population, both of who overwhelmingly vote Democrat, are not fully vaccinated. 


  • “Your likelihood of dying from COVID-19 if you’re vaccinated is one in a million. If you’re not vaccinated, it’s one in 50. That’s what vaccines do — and that effect seems to be reasonably durable.”   per Dr. E. John Wherry, director of the Penn Institute of Immunology. “Boosters may prove to be helpful, but they’re not going to address the biggest problem the country still faces – all the unvaccinated people spreading COVID-19.”


  • The Delta variant is not only much more infectious than earlier versions of the new coronavirus, but it’s also twice as likely to land you in the hospital with life-threatening complications shows a new study on 43,000+ COVID-19 cases that was published Aug. 27 in The Lancet. This data shows that the unvaccinated have much more to fear from the Delta variant since the vaccines prevent serious illness


  • Live entertainment is back, says Joe Berchtold, president of Live Nation. “All of our festivals — Lollapalooza, Bonnaroo, Governors Ball — are selling out faster than ever,” Consumers, who have been unable to gather at live concerts and shows for more than a year due to the Covid pandemic, are “showing up and spending money,” Berchtold said the company’s vaccine policy requires audience members to either be fully vaccinated or provide a negative coronavirus test to gain entry to events. More than 90% of the attendees of Lollapalooza were vaccinated, he said. Of those, 12% said they got vaccinated because they wanted to attend the festival.


  • In a recent study, published online in late August, Dr. E. John Wherry, director of the Penn Institute of Immunology and his colleagues showed that, over time, people who have had only two doses of the vaccine (and no prior infection) start to make more flexible antibodies — antibodies that can better recognize many of the variants of concern. So a third dose of the vaccine would presumably give those antibodies a boost and push the evolution of the antibodies further, Wherry says. So a person will be better equipped to fight off whatever variant the virus puts out there next.


  • Children remain markedly less likely than adults to be hospitalized or die from Covid-19. But the United States recorded more than 250,000 child virus cases in the past week, the highest number to date, according to the most recent American Academy of Pediatrics survey of state data. Experts have said that vaccinations can make all the difference. States with the highest vaccination rates in the country have seen relatively flat pediatric hospital admissions for Covid-19 so far, while states with the lowest vaccine coverage have child hospital admissions that are around four times as high.


  • The World Health Organization has warned that booster shots could divert vaccine supplies from countries with largely unvaccinated populations. On Wednesday, the agency asked wealthy countries to hold off on administering booster shots for healthy patients until at least the end of the year as a way of enabling every country to vaccinate at least 40 percent of their populations. Officials are not opposed to additional doses for the immunocompromised. Some studies suggest that the protection that the vaccines provide against infection and mild disease may be waning. But they remain highly effective at preventing the worst outcomes, including severe disease and death, and scientists have said that a blanket recommendation for boosters is premature. The W.H.O.’s Africa director, Dr. Matshidiso Moeti, said, “If producing countries and companies prioritize vaccine equity, this pandemic can be over quickly.”


  • Qantas, Australia’s largest airline, will require that all passengers on international flights are vaccinated against the coronavirus when it restarts worldwide operations in December. Other airlines have announced that they will require flight attendants and pilots to be vaccinated, but few other airlines have committed to banning unvaccinated passengers.


  • Israel plans to allow visits from organized groups of vaccinated tourists after Yom Kippur, the holiest day of the Jewish year, taking a step toward reopening to the world. The pilot program will come into effect on Sept. 19, allowing the entry of groups of five to 30 people on condition that they adhere to a host of virus-related measures, including providing a negative P.C.R. test taken 72 hours before landing and undergoing a second test as well as a serological examination upon arrival, the ministry said. All travelers will be required to show proof of being fully vaccinated within the previous six months or proof of having received a booster shot, the ministry said, with a vaccine approved by the Food and Drug Administration or the European Medicines Union.


  • Several E.U. member nations — including Bulgaria, Italy, the Netherlands and Sweden — have imposed new restrictions after the bloc removed the United States from a list of safe countries. 
  1. Italy now requires U.S. travelers to take a test before arrival.
  2. Sweden is barring all nonessential U.S. visitors
  3. The Netherlands says vaccinated travelers must quarantine and unvaccinated people should stay away.
  4. Most E.U. countries, including France, Spain and Germany, continue to welcome U.S. travelers without much hassle.


  • Researchers in Israel compared the rates of infection after vaccination — called breakthrough infection — with the rates of reinfection. The analysis indicated that people who had never had the infection and received a vaccine in January or February of 2021 were up to 13 times more likely to contract the virus than people who had already had the infection.  The findings suggest that natural immunity provides longer-lasting and stronger protection against infection, symptomatic disease, and hospitalization due to the Delta variant, compared with the protection of the Pfizer-BioNTech two-dose vaccine, the researchers conclude. In addition, those with natural immunity exhibit additional protection against the Delta variant when given a single dose of the vaccine, according to the results. Scientists warn that intentionally not getting vaccinated and then catching COVID-19 also puts you at high risk for serious illness and death so you should get the vaccine to protect you. 


  • A recent study, which appears in the Journal of the American College of Cardiology, reports that metoprolol can reduce lung inflammation and improve respiratory function in people with acute COVID-19. Approximately 14–33% of individuals with a SARS-CoV-2 infection develop severe illness, and about two-thirds of those with severe illness develop ARDS. ARDS involves injury to the lung tissue due to inflammation and the accumulation of fluid in the air sacs in the lungs where the exchange of gases occurs with blood vessels. Metoprolol is a common beta-blocker designed to treat high blood pressure, and it may provide an inexpensive treatment for severe COVID-19.



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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147


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