Friday Night Update from the ER in Arlington, VA: Cases “down to the single digits with COVID patients who are hospitalized. We’re not there yet but getting there.”

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

COVID numbers continue to look good in the emergency department and in the hospital. Before we get into the details of those, let us talk about some real-life things.

The Covid tests that I ordered from the Federal Government finally arrived. It took about a month or so. I am also seeing plenty of COVID tests at the pharmacy. If and when the next surge arrives, it is good to know that our supply of rapid tests is better than it was a couple of months ago.

I was in CVS yesterday picking up a prescription when they announced overhead that every customer could get 3 free N95’s. While I obviously have access to N95’s at work, I do not really have a home supply and I wanted to check these out. They were actually really decent, high-quality, true N95 masks. I encourage everyone to see if your CVS or other local drugstore, has these in stock. It is definitely worth keeping a few on hand.

My son’s school went mask “optional” this week. He was very excited. I have a little bit of concern. He is 16 and I have asked him to use some common sense about wearing a mask, particularly if he is sitting next to someone who is coughing a lot. We will see how it goes. I would be surprised if he has a mask in his backpack at the moment.

I was also called by a doctor from the CDC this week. He was investigating a possible Covid vaccine allergic reaction. He explained his role in the process to me and then we reviewed the case. Although an allergic reaction to the vaccine is possible, fortunately, it is very rare. In this case, he and I decided that the history and clinical picture did fit an anaphylactic reaction and that this patient would be recorded as a true allergic reaction to the Covid vaccine. The patient was treated with epinephrine at the pharmacy, improved very quickly, and did well afterwards.

We are still seeing COVID in the emergency department obviously. The number of patients that we’re putting on COVID isolation actually increased a touch this week compared to the previous week but the total number of positives we have seen has been constant the last 2 weeks. The number of positives is still higher than we see during our real lulls, and I am hoping it continues to decline a little bit. I spoke to a friend who works in a similar sized ER/hospital who had similar COVID hospitalizations to us. They are down to the single digits with COVID patients who are hospitalized. We’re not there yet but getting there.

Although the Covid numbers are declining, there is still plenty of news regarding Covid. The Pfizer vaccine for the 5-11-year-old age group hit the news a couple times this past week. First, there was a study out of New York that suggested the vaccine may not be as effective in blocking milder infections for this age group compared to teenagers. This raised the question whether the dose needed to be adjusted with this age group and if they needed a booster. However, then the CDC released data from a multistate analysis showing that the vaccine gave children strong protection against hospitalization and death, even during the Omicron surgery. The CDC went on to suggest that it wasn’t the children’s age or the dose size leading to issues in the NY study, but rather that Omicron was so much more contagious than earlier versions of the virus. The CDC’s study looked at pediatric hospitalizations in 10 states from last April to the end of January. The vaccine was found to be “74% effective against hospitalization 5-11-year-olds. Only 2 vaccinated children were hospitalized compared to 59 unvaccinated children.” The vaccine was highly effective against hospitalization in the 12-17-year-old age groups as well. There was also a relationship between children who were vaccinated having a reduced amount of emergency department or urgent care visits across ages. The CDC found that “unvaccinated 5-11-year-olds were 1.3 times more likely to get Covid in January, at the height of the Omicron surge and vaccinated kids. For the 12-17-year-olds, unvaccinated patients were 1.5 times more likely to get Covid the vaccinated peers.” Kids over the age of 5 should be getting vaccinated and those over the age of 12 should get their booster.

There was a study published in the American Journal of Cardiology out of MedStar that looked at more than 6700 emergency department visits to determine if there was a link between the Covid vaccination and cardiac issues. The authors concluded “vaccination does appear to significantly lower the risk of ED visits respiratory infections and Covid 19 related complications.” Additionally, “COVID-19 vaccination does not increase the patient’s risk of visiting the emergency department for significant cardiac issues such as myocarditis or myocardial infarction.”

The origin of this particular Coronavirus variant has been a question since the beginning. Did it really occur at a market or was it in the laboratory in Wuhan. This week, there were 2 preprint papers released that concluded that the virus was present in animals at the wholesale market in Wuhan by November 2019. It is at this market that the virus jumped to human host on 2 separate occasions a week or so apart. There have been concerns about viruses jumping from animals to humans in the past and each paper concludes that Covid started this way. Hopefully additional measures will be put in place for markets that use wild animals to prevent this in the future.
The Coronavirus is not done with us yet.

Science matters. Get vaccinated (or your booster). Keep a mask handy.

Mike