Hello everyone,
I know it’s been a long time since my covid update. It has been a bit of a crazy 2022 thus far with lots going on. I know many of you have had questions on covid recommendations. Hopefully this update will answer those. The good news is that covid has become a much milder disease over time here in the US. This has happened because of the high protection offered by vaccination immunity and through natural immunity. At this point, so many people have either had covid or been vaccinated or both that the disease is significantly more mild. Seroprevalence (how many people in the US have had covid) after the omicron wave Dec-Feb is 60% of US adults and 75% of US children. We are again seeing an uptick in cases, but very low hospitalization rates and even lower ICU rates. Our two years of sacrifice through mitigation efforts did pay off in that regard. Here are the latest numbers:
Testing positivity is no longer useful to look at since so many people test at home and home tests go unreported but are widely accepted tests now. Instead, we will look at daily cases per 100,000 people.
Lake county, IL:
Daily cases per 100,000 people: 212 (omicron peak was >2000 per day)
Hospital admissions per 100,000 people: 5
Inpatient hospital beds used for covid: 1.8%
Fully vaccinated: 79% (84% of those ages 5-11, 87% of those ages 12-17, 87% of those 18-64, 93% of those 65 and older)
*deaths: not reported, numbers too small
Kenosha county, WI:
Daily cases per 100,000 people: 102 (omicron peak was >800 per day)
Hospital admissions per 100,000 people: 5
Inpatient hospital beds used for covid: 1.8%
Fully vaccinated: 79% (84% of those ages 5-11, 87% of those ages 12-17, 87% of those 18-64, 93% of those 65 and older)
*deaths: not reported, numbers too small
Racine county, WI:
Daily cases per 100,000 people: 90 (omicron peak was >900 per day)
Hospital admissions per 100,000 people: 4
Inpatient hospital beds used for covid: 1.1%
Fully vaccinated: 61% (65% of those ages 5-11, 69% of those ages 12-17, 72% of those 18-64, 93% of those 65 and older)
*deaths: not reported, numbers too small
Questions on vaccine 4th dose:
The FDA has authorized a fourth Pfizer or Moderna Covid vaccine dose for anyone age 50 and older. It also issued approval for a second booster/4th dose of Pfizer for people 12 and older with immunocompromised conditions and Moderna for people 18 and older. All second boosters must be at least 4 months after the third dose. The approval came due to concerns that a more contagious version of omicron will cause another wave of infection in the US, as has been seen in Europe and China.
Many people have been wondering if they should get a 4th dose. The data shows that a 4th dose/second booster provides an increase in protective titers, but that effect is short lived- weeks to maybe 1-2 months. The 4th dose gives less robust of a response than doses 1-3. It does not protect against you getting covid. It may protect against you passing it on through reduced viral load. It does protect against severe disease. It is most effective in older adults >65 years old and in immunocompromised persons. Recommendations are to get a 4th dose if you are older than 65 or immunocompromised. Many other people have also gotten a 4th dose because they want to boost up their titers and increase protection for some other reason (most common I have seen is an upcoming trip that requires a negative covid test). There is no significant harm to a 4th dose as compared to the other three doses in terms of vaccine injury. A 4th dose makes sense if you are older than 65, immunocompromised or have some other motivation for wanting a brief (3-6 weeks) boost in your protective titers.
Beyond that, both vaccines do not offer any different formulation to account for the many mutations from original covid to delta and then to the significant mutations of omicron. These mutations account for the vaccine breakthrough infections we see. We are no longer able to prevent covid through vaccination due to the current mutations but are still able to decrease severe disease and death.
Please remember it is so important to be guided by what is going on locally in your community. In our local community and most of the US right now, the newer European variant causing a surge in Europe and some parts of China is not causing that issue in the US. That variant is absolutely here and is the dominant variant, but as we are a different population with different demographics, resources, immunity rates, we are not a carbon copy of what is happening elsewhere. The second part of what should be guiding you on your decision is what your risk tolerance is and what your goals are. If you are one of the 40% of Americans who have never had covid and want to avoid it, you will be making different choices than someone who just had omicron four months ago. The variations are endless so focus on what’s going on in your community, what your goals are, and what risks are acceptable to you. Realize that others may come to different choices.
Paxlovid- oral covid medication:
This is still difficult to get but is becoming more available. It is still only distributed through a government program so only pharmacies with government ties or funding are receiving this. It is only available for outpatient confirmed covid infection who are at high risk for progression to serious illness.
Here are the inclusion and exclusion criteria. Studies of otherwise healthy adults did not show any benefit from this medication in trials. Side effects can be altered taste, diarrhea, muscle aches. Drug interactions can be significant. You may need to stop taking certain chronic medications while on this medication (for example, statins). The benefit was a relative risk reduction of 88% however numbers of the trial were small (2,246 participants) so the absolute risk reduction was 5.6%.
Being on paxlovid did also not prevent transmission to other close contacts.
Inclusion criteria:
Confirmed mild or moderate COVID-19 infection with at least 1 symptom
High risk for progression**
Exclusion criteria:
Hospitalized patients due to COVID-19 (except CLC patient for isolation purpose)
Requiring oxygen supplementation to maintain O2 saturation >94% (or increased supplementation required if on oxygen at baseline)
Requiring mechanical ventilation
**High risk definition
Age ≥ 60 years
Diabetes
BMI > 30
Chronic lung disease (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)
Chronic kidney disease
Immunosuppressive disease or currently receiving immunosuppressive therapies
Cardiovascular disease (including congenital heart disease) or hypertension
Sickle cell disease
Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)
Active cancer
Having a medical-related technological dependence [for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID 19)]
Other treatments- monoclonal antibody infusions:
The FDA has been closely monitoring when a Monoclonal antibody infusion is no longer effective against a particular strain and will recall its distribution until another version can be released. Currently that Mab is Bebtelovimab, and it has good outcomes thus far at preventing progression towards severe infection, decreasing risk of hospitalizations and providing noticeable symptomatic relief in about 12-24 hours.
I will try to update on the other news and pediatric under five years old vaccine data soon as well.
I hope everyone is thrilled we made it through a covid Winter and are looking forward to Spring, should it decide to ever come.
Dr. Green
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Jill Green MD
MedLogic Primary Care
www.MedLogicMD.com
Bannockburn IL & Kenosha WI