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
Two years ago today COVID was declared a pandemic.
Yet, this is a bit of a milestone week for me. My first Friday Night Update Facebook post about the pandemic was on the second Friday in March 2020. I think I’ve taken one Friday off in the last two years and with today’s post, I’ve crossed over 145,000 words (my word document is 267 pages).
Next up, was the return to in-person learning for the leadership course I teach for my company. I teach a 5-session course that takes place over a year and our March 2020 course was the first one I ever did virtually. We’ve been virtual until this past Tuesday when we met in person. It was the first time I was back at our corporate HQ in 2 years as well.
Finally, as the pandemic was starting two years ago, my daughter’s lacrosse team was on their way to play Christopher Newport University. The decision had already been made not to allow spectators at the game. As the team was in the bus driving there in March 2020, they were told the game would be cancelled. They turned around and basically went home for the semester. This week, they returned there to play the game and I was able to attend. That’s full circle.
We all have signs of returning to normal. But let’s not forget the 6 million people who have died of COVID around the world and the nearly 1 million Americans who have died. The CDC tracks excess deaths, defined by the CDC as “the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods.“ The graphs are really staggering and I have no doubt that we’ll continue to learn about the impact of COVID for years to come.
The ER reflects all the positive things going on as well. Our number of cases is low (holding steady the last few weeks). We continue to test >400 patients a week and we’re running a positivity rate of about 2.2%. Most of our tests are done on asymptomatic patients—those being admitted to the hospital for non-COVID related complaints or when COVID is part of the differential diagnosis but the patient doesn’t meet true COVID criteria. Among our inpatients, we’re flirting with single digits of patients hospitalized with COVID. We are all trying to get back to normal, at least temporarily. (Vaccines and boosters are key)
There’s some news on the treatment front for hospitalized patients. There’s a drug for rheumatoid arthritis named baricitinib, which appears to reduce mortality in hospitalized patients when used with other standard therapies. The data is out of the RECOVERY trial in the UK (which involves 178 hospitals and has enrolled 47,000 patients), and when added to standard treatments, like dexamethasone, mortality was reduced 13% compared to patients who didn’t get the medication. Additionally, patients who received the med, were more likely to be discharged within 28 days. Important to note was that the mortality rate was 14% without baricitinib and reduced to 12% with it. While that reduction is nice, there’s still a 12% chance of dying for hospitalized COVID patients.
Although mask mandates have disappeared and we’re returning to life as normal, COVID isn’t over. I’ve heard many experts suggest that we’d be better if we kept masks on for a bit more. The BA.2 variant is now up to 11% of new cases and the number of cases attributed to the variant has been doubling every 2 weeks. The BA.2 variant appears more transmissible (spreads 30% faster) than the BA.1 variant (original Omicron) though isn’t more serious. Many countries around the world are seeing an increase in cases because of BA.2. The UK lifted all measures on February 24th and the country has seen significant increases in new cases over the past week. New positives are up 58% compared to a week ago. Hospital admissions, considered a “lagging indicator,” have started to creep up in the past week as well. While the UK numbers are not staggering, it’s a trend in the wrong direction and worth following for now.
There was a fascinating study out of the UK looking at the impact of COVID on the brain. The UK has a databank of volunteers who underwent MRIs and cognitive testing prior to the pandemic and researchers from Oxford studied 401 patients ages 51-81 who had baseline data in the databank and now had a history of COVID, and invited them back for further testing. This group was compared to a control group that was similar in age, rates of obesity/smoking/hypertension, etc… and did not have COVID. The findings are concerning: “compared with the control group, those who had Covid experienced an additional 0.2 percent to 2 percent loss of brain tissue in regions which are mostly associated with the sense of smell. The overall brain volume in people with Covid declined by an extra 0.3 percent over those without the disease.” The COVID group also experienced a decline in cognitive testing—the ability to manage complex tasks. The lead author said the impact is equivalent to at least one extra year of aging. While it’s a potentially reversible impact, it’s not yet known if the damage is permanent, and more studies will need to take place.
Flu season is about over, which is a good thing. There was a report from the CDC this week saying that the flu vaccine did not provide particularly effective prevention this year. Remember, the flu vaccine is scientists best guess based on surveillance data at what will be the predominate strains during flu season. Fortunately, due to prevention strategies such as masks, flu season was very light from an ER perspective. We averaged 1-2 cases a day during the peak of winter, dropping to one positive every 2 days in February, and maintained a positivity rate <3% for flu—all of this is way below our norm. I certainly recommend continuing to get flu shots in the future but if there was going to be a miss on the strains in the vaccine, this was a good year to have it.
I got a lot of comments last week asking about vaccinations for those <5. As I said a couple of weeks ago, 3 of my good friends had COVID go through their families after their <5 year olds got COVID at daycare. Certainly, last fall, we all felt pretty optimistic that vaccine approval would be her by late 1st quarter 2022. I feel your pain and stress. I’m reading that both Pfizer and Moderna should have results on kids to present to the FDA in the near future. The issue seems to involve the dose and whether a third dose can give the necessary level of protection. Other companies like Novavax and Sanofi are also being studied. Getting kids of all ages vaccinated is critical and it does appear that some starts will start to require it (Louisiana, California, and DC) even though the Florida Surgeon General declared that healthy children don’t require the vaccine.
The Coronavirus is not done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.
Mike
Sign up for the Blue Virginia weekly newsletter
