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Friday Night Update from the ER in Arlington, VA: “I think it speaks to COVID being part of daily existence, and that we still need to track the numbers”

"Although I do plan on getting a second booster, I haven’t scheduled it yet."

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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

My shift yesterday was the first time since the pandemic began that I didn’t wear a surgical cap. We all wore caps and other PPE initially and through each surge. I’m obviously not protecting my hair (since I don’t have any) by wearing a cap, but I did like the concept of possible keeping less COVID off me, the padding/protection it gave me from the elastic straps of the N95s, and the ability to put the ear loops from a surgical mask over buttons on the cap instead of my ears. I’ve been out of an N95 for about a month, so I made the decision to ditch the cap for now.

Johns Hopkins University reported this week that approximately 100 students tested positive since spring break. They very quickly pivoted back to twice weekly testing for undergrad students for 1-2 weeks and reinstating masking requirements. These kinds of rapid changes are what I expect to see from time to time for a while.

Although our ER numbers still look good regarding COVID, we saw another increase in the number of patients we diagnosed with COVID this week, compared to previous weeks, and another bump in the percent positivity rate. This is the highest number of cases we’ve had since mid-February. I think it speaks to COVID being part of daily existence, and that we still need to track the numbers, I hope society is patient enough to pivot like Hopkins did if/when we get another surge.

Although I do plan on getting a second booster, I haven’t scheduled it yet. I’m also heading to two conferences over the next few weeks, so I do believe routine life events can generally take place.

The BA.2 variant represents about 73% of all new infections. It’s highly transmissible but does not seem to cause more severe disease than other COVID variants. However, it does have an impact on our treatment. One of the monoclonal antibody treatments, sotrovimab, has been found to be ineffective against the BA.2 variant and the FDA has withdrawn its emergency use authorization for this treatment. There is one monoclonal antibody, bebtelovimab, that appears effective against BA.2. so we are now using that one. Additionally, remdesivir given daily for 3 days through an IV may be effective as an outpatient treatment for some patients. The new oral medications are meant for patients with risks of severe disease. They do not shorten the duration of symptoms but offer some protection for high risk patient populations against hospitalization and death.

There are two new papers from the CDC’s MMWR worth mentioning. First, a paper from Hong Kong looking at mortality risk for vaccinated versus unvaccinated in the 60+ age group. The risk of death was 20 times lower for the vaccinated group. Next is a report analyzing data from 40 health care systems participating in a network. Authors compared the risk of cardiac complications related to COVID versus the mRNA vaccine. The risk of heart complications such as pericarditis and myocarditis, “is higher after COVID 19 infection than after mRNA vaccination among males and females of all ages.” The vaccine is safe, and it saves lives.

The Coronavirus is not done with us yet.

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

Mike

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