Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency medicine at Virginia Hospital Center, for these helpful updates!
Friday Night Update from the ER in Arlington, VA
The number of patients we have hospitalized with COVID finally started to decrease this week. We had been in the same ballpark for several weeks, but as I sit here today, our inpatient census is about 38% lower than its been the last few weeks (it was only 20% lower yesterday). We did expect this to happen as the numbers of new cases have started to decrease over the last several weeks but is always nice to see the real numbers decline. The number of newly diagnosed COVID patients in the emergency department continue to look pretty good. Among her symptomatic patient population, the average number of new patients per week averaged over the last 3 weeks is about half when compared to the 3 weeks prior to that. Our percent positive rate has also dropped accordingly. We see similar drops when we look at all positive tests among patients in the emergency department. We have seen continued improvement over the last 3 weeks with about half the number of cases compared to the 3 weeks before that. You must go back to July to see so few cases in the same week. Recall that July was when the delta variant first hit our radar, but we did not start to see a bump in cases until early August.
I’ve worked clinically a lot the last week or so (including today which is why this is posted later than usual). Although we’re not seeing a lot of COVID, the ER and the hospital is still really busy. I can’t explain it all, but one trend I noticed recently is the complications I’m seeing from lack of primary care. I’ve seen so many patients go without treatment—ranging from cancer to those with Parkinson’s, hypertension, and diabetes going without medications for a year or more. Lack of care for chronic illness leads to worsening disease and complications. We’ve also started to see a lot of younger kids coming in. Many of these kids have non-COVID viruses such as Respiratory Syncytial Virus (RSV) or Rhinovirus (the common cold), but young kids can get pretty sick. It’s certainly hypothesized that younger kids haven’t had the routine viral illnesses they would typically have gotten over the last 18+ months due to isolation, daycare closures, etc…and therefore haven’t built up their immune system the way kids would have done just a few years ago. It turns out that some germs, exposures, and colds are good for building our immune system for babies and young children.
This has been a great week for vaccines. As we have seen, the FDA has moved ahead with the recommendation for the Pfizer vaccine for the 5-11-year-old age group. Although most kids with COVID will be fine, COVID has become the 8th leading cause of death for the 5-11 year old age group and vaccinations will save lives. We certainly need to look ahead to the CDC for approval next week and we expect pediatricians and pharmacies to be able to start administering the vaccine the first week of November. As a reminder, the pediatric dose for this age group will be one third of the adult dose and children will still require 2 doses. More than 1500 vaccinated kids were followed for adverse affects for 2 months after their second dose of vaccine and the risk/benefit ratio clearly favors the benefits of the vaccine.
I hope every eligible child gets the vaccine. There are no contraindications and while there is a very small risk of myocarditis, the risk of COVID related myocarditis is 16X greater than vaccine related myocarditis and COVID myocarditis typically is more severe. If your child has already had COVID, getting the vaccine will lead to even better protection than vaccine alone.
There is also some discussion about people that are immunosuppressed. This was the initial group of people who received boosters but there is data showing that the same patients may require a fourth booster 6 months after their third shot.
Moderna also announced that their vaccine works well for children ages 6-12. The children vaccinated in this trial had antibody levels 1.5 times greater than those reported in young adults 1 month following the vaccine. The study involved 4753 children ages 6-11 who either got vaccine or placebo. Side effects were similar to adults with fatigue, headache, fever, and pain at the injection site. The pediatric dose of the maternal vaccine that was tested was half the dose, 50 mcg, of the original adult vaccine.
A little over a year ago I wrote about an antidepressant that may reduce COVID symptoms in patients. There was a very small study and I brought it up just because it was interesting to see how meds not designed as anti-virals could end up being beneficial. There is now a much larger study that included 1500 Brazilian adults that was published in the Lancet Global Health, that looked at fluvoxamine, a pretty common antidepressant. The patient population was COVID positive patients with a known risk factor for progression to severe disease from 11 clinical sites who were randomized to either receive the antidepressant medication or a placebo. It appears that the patients who received fluoxetine were about one third less likely to require hospitalization. Patients from both groups still had deaths secondary to COVID, so vaccine remains our best way to reducing illness and death. However, finding an oral medication that can help keep people out of the hospital will ultimately be a game changer.
If you work in the ER long enough, you definitely get to know the local police. This week, we celebrated National First Responders Day and recently we had National Police Week. The attached photo is me with one of my all-time favorite police officers, Officer Velez. Officer Velez is frequently in the emergency department assisting us with patients and she has an amazing bedside manner. She is also wearing her pink outfit, in honor of breast cancer awareness month. The pink hat goes back to her days on the Arlington Motorcade about 8 years ago. Since then, she has added her pink T-shirt, her pink whistle, and now because of Covid, she can wear a pink mask.
Science matters. Get vaccinated. Wear a mask. We’re not quite there.