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
Our COVID volume remains steady. There has been a slight drop in the number of our “symptomatic” patients we diagnose since mid-May. However, as we look at the total number of positives week to week, the numbers and percent positivity are similar for the last 6 weeks.
The Omicron variant has led to several subvariants. We’re currently up to BA.4 and BA.5 and they’re making up about 35% of cases in the US. That number continues to increase week to week. So why is this important? Lots of people were infected with Omicron over the winter and while in 2020, infection was believed to lead to some sort of lasting immunity (possibly 6-12 months), it’s much less clear if getting infected with the BA.2 variant will protect you against BA.4/5. In fact, experts believe there is not much cross protection between variants because the newer variants contain so many critical mutations. While infection with BA.2 likely offers protection against reinfection with BA.2, experts think protection could be limited to weeks against the newer variants.
Fortunately, Moderna released data this week about its new combination vaccine booster. This vaccine combines the original spike protein target along with BA.4 and BA.5 subvariants. This combination led to a five fold increase in neutralizing antibodies, which is the key to preventing infection. Moderna has submitted this data to the FDA and believes the new vaccine could be available later this summer.
In a study published this week in the Lancet Infectious Diseases, authors used a mathematical model to evaluate the impact of the vaccine during its first year of availability. The authors estimated that 20 million deaths were prevented worldwide during 2021 because of the vaccine. They also estimated that 45% of the excess deaths (about 600,000 lives) seen in low-income countries could have been avoided had 40% vaccination coverage targets been set (and achieved) by the World Health Organization instead of 20%. Vaccinations will continue to save lives. In another article published in JAMA this week, data showed that a 4th Pfizer shot “protected seniors in long term care from the most severe outcomes during the Omicron wave.” The second booster showed about 65% protection against hospitalization and 72% against deaths compared to individuals who had not received the extra booster. We need to continue to get vaccines into arms.
I had a chance to see a friend this week that I worked closely with in the early days of COVID. It’s amazing to me how far we’ve come in just over 2 years. We talked about the initial response, the meetings, the early days of the vaccine, and the stress. In many ways, I’m glad I captured so much of what I experienced via these Facebook posts. Although COVID is still with us, I haven’t had a COVID meeting in weeks. The disease has just rolled into the routine of the ER and the hospital.
Coronavirus is not done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.
Mike
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