Home Coronavirus Friday Night Update from the ER in Arlington, VA: “I suspect all...

Friday Night Update from the ER in Arlington, VA: “I suspect all of us will get [COVID] at one point”; “the chances of long COVID remain real”

Also: "There is a lot of good news on the vaccine front."

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Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency Medicine at the Virginia Hospital Center in Arlington, for these superb updates!

Friday Night Update from the ER in Arlington, VA

Dr Fauci got COVID this week. I don’t know all the details, but I think it goes to show that even our top infectious disease specialist can get sick. ID docs tend to be very careful and cautious so I would be willing to bet that he was taking a lot more precautions than the average person. I’ve said to my wife and kids several times over the past 6 months that I suspect all of us will get it at one point. But I also don’t want to just give up as the chances of long COVID remain real (about 5% during the Omicron wave though down from almost 11% during the Delta surge). Also, a very small percentage of people get really sick and there’s a small percentage of those that get critically ill who don’t have significant risk factors.

There is a lot of good news on the vaccine front.

The FDA gave emergency use authorization for both the Pfizer and Moderna vaccines for kids 6 months and older earlier today. There’s about 18 million kids under the age of 5 in the US who previously had not been authorized to get a vaccine. By early next week, pediatricians should have vaccines available in their offices. Previously, Moderna’s vaccine was approved for 18+ and Pfizer’s for 5+. Although nothing has gone easy for the youngest age group, todays news was expected after an FDA advisory panel unanimously voted to approve the Pfizer vaccine for children 6 months to 5 years old earlier this week, saying the benefits of the vaccine outweigh the risk. Although there’s only been 442 deaths of kids under 5 and most cases of COVID in this age group are mild, this is very welcome news for so many when looking at individual household safety. The data looks good for both vaccines though the two vaccines have not been tested against each other so it’s unclear if one is better than the other. The Moderna shot uses ¼ of the adult dose and the two-shot series appear strong enough to prevent severe disease but are only 40-50% effective at preventing illness. The 3rd shot is being studied. The Pfizer shot uses 1/10 the adult dose and is a 3 shot series, as the initial data on 2 shots was not found to be effective enough. The 3 shot series was found to be 80% effective in preventing illness. The Moderna vaccine will be a half shot dose for 6-11 year olds and a full shot dose for teens. Only about 29% of kids ages 5-11 have received the Pfizer vaccine since they became eligible last November and it’s estimated that about ¾ of all kids have been infected. The next step is for the CDC advisory committee to meet to decide if the vaccines should be approved for all kids or just a subset (high risk). These meetings started today. Don’t go to your pediatrician today but they should have vaccine available soon.

In other vaccine news, Sanofi released a statement this week that it’s next generation vaccine candidate (in conjuncture with Glaxo Smithkline) showed potential as a booster shot in two trials against the viruses main variants of concern, including BA.1 and BA.2. The booster is being reviewed in Europe and results show an increase in antibiody levels against these variants of concern in patients that received Pfizer or Moderna previously.

Paxlovid will clearly continue to play a role in treating COVID. A few weeks ago, I wrote about an Israeli study that showed Paxlovid was beneficial in preventing severe disease in those 65+ but not found to prevent severe illness in those <65. Now Pfizer has stopped enrolling patients in a study using a “standard risk” patient population as the preliminary data was not found to be statistically significant. What does this mean? Patients without high risk components such as being elderly or having underlying lung disease, diabetes, and/or obesity can recover without the drug without an increased risk of progressing to severe disease (when comparing those who took the medication against those who didn’t).

Let’s look at the VHC data. The number of hospitalized patients with COVID now is down about a third compared to last week. Over the past month, we’ve seen a slow but steady decline in the number of ER patients who have been placed on our “COVID isolation” protocol. And we’ve seen a decline in the number of these patients who require admission to the hospital. On the testing front, our total number of positives has remained fairly constant the last 3 weeks. Our 6 week percent positivity average is 8.9% and our last 3 weeks are running about 10.3%. We’ve also seen pretty consistent numbers when we break it down between symptomatic and asymptomatic patients.

For perspective, +/- 45% of our current weekly patients get COVID tests for one reason or another. In 2020, if we had 60 patients test positive a week, that was a lot. In June 2020, we were seeing 20-25 positives a week. (keep in mind, there’s always patients who come in with a known positive that we don’t retest). Our winter surge in 2020-2021 set the high water mark at the time, when we were seeing 90-100 positives a week. And then COVID seemed to disappear last June. We had a 6 week run of 0-8 cases a week in the ER. Our perspective really shifted around New Year’s this year when we had about 700 cases over a 2 week period. (Thanks Omicron). But March and April of this year was light again with just a couple of positive cases a day. Unfortunately, we’ve been running in the 50-60 a week range for the last month or so. This is nothing compared to last winter (and certainly less patients are being admitted), but it far exceeds the last two Junes.

This was an interesting week for me. I worked 3 shifts. I virtually attended the Arlington County Chamber of Commerce Public Service Awards. EMS, Fire, and Police have always done heroic work and these award ceremonies are pretty impressive. I also participated in our hospital’s nursing awards ceremony this week. I posted some pictures earlier this week. The nurses are equally heroic after the last 2+ years as well. It’s amazing to me how many winners were current or former ED nurses. I also gave a lecture to a graduate school class on lessons learned from COVID. After working last weekend, I’m ready to relax this weekend.

Coronavirus is not done with us yet.

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

Mike

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