Friday Night Update from the ER in Arlington, VA: “This past week was the best COVID week we’ve had in a long time in the ER”

Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency medicine at Virginia Hospital Center, for these helpful updates!

This past week was the best COVID week we’ve had in a long time in the ER. We actually didn’t have any positive cases among our “symptomatic” patients and just a handful or so among all comers to the ER. Our percent positivity rate was <2%. Hospitalizations remains low and we are returning to normal with in-person meetings and some options about mask wearing in non-clinical areas.

I worked yesterday and didn’t even wear an N95 mask (first time in months). We have had a couple of sick COVID patients recently and it’s interesting to hear the docs talk about it, since none of us really remember when the last ICU COVID pneumonia patient we admitted was. With that said, the CDC released data saying the BA.2 variant climbed to 23% of cases as of March 12th. There was also a report this week out of the CDC that a wastewater network that monitors COVID is reporting a rise in cases. About a third of sample sites across the country reported increasing amount of COVID during the first 10 days of March; this was about double the number compared to the first 10 days of February. It’s unclear how many cases this equates to and if this means we’re on the edge of another surge or not. However, with waning immunity from those who got boosters last fall, a more transmissible variant, and increasing cases in Europe, I’m more and more concerned that we will be returning to mask wearing in the near future. I’ve seen many experts predict another surge in the next few weeks. Flexibility and adapting to the current situation remain critical for all of us.

I’ve received a lot of questions about a 4th vaccine dose. Currently, in the US, a 4th dose (second booster) is only recommended for those who are immunocompromised. (I had a patient yesterday who was significantly immunocompromised and had sepsis, but not COVID). The early data looking at a 4th dose appeared to show that it didn’t prevent infection any more than a 3rd dose did, nor did it reduce hospitalization/death more than a 3rd dose. However, that research was done before Omicron. During the Omicron phase, effectiveness against hospitalization was 91% for those who received their booster within 2 months of getting COVID but only 78% for those who got their booster >4 months earlier. We know the benefits of vaccination wane over time (at this point). Many of us are a solid 6 months status post our 3rd dose (first booster) and many certainly have concerns about waning immunity. This week Pfizer asked the FDA to authorize a 4th dose for those over 65 year of age. Not to be outdone, Moderna also requested approval for a 4th shot for those 18+. Israel is already offering a second booster for those 60 and older and to healthcare workers. Pfizer is stating that among “1.1 million Israeli seniors, infections were two times lower and ratees of severe infections were four times lower among those who got two boosters instead of just one.” Inevitably, we’ll get another booster. Hopefully soon. Keep in mind that <50% of eligible adults have gotten a booster so there’s some work to do with that population as well.

Today (and tonight) has really been about my wife. She’s getting an award at the National Space Club (The Goddard Memorial) Annual Dinner tonight for work she did last year (really the last many years). It’s an amazing party and I’m really thrilled to see her get recognized for the work she did that involved thousands of people across many companies. My wife is an aerospace engineer and has a job that is in many ways the total opposite of being an ER doc. ER docs show up, see patients, leave when the shift ends, and then come back and do the same thing at the next shift. It’s all a little random and unplanned. There’s also always another patient to see so getting a sense of accomplishment can be hard. My wife spends years planning a project, working through it one step at a time, resulting in a rocket to launch and a satellite and whole accompanying system (ground, communications, etc) to actually work as planned. It’s pretty amazing, with a definite sense of accomplishment and achievement as an end result. The award is icing on the cake. It should be an exciting night.

The Coronavirus is not done with us yet.

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

Mike