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
COVID continues to make its way through the community. I am probably not the only one who has a colleague out with COVID this week or who was called by someone they encountered during the July 4th weekend that tested positive for COVID this week. The total number of people we diagnosed with COVID this past week is more than 10% higher than what we have been averaging on a week-to-week basis. Our overall percent positivity rate was 12.5% with a 6-week baseline average of 10.5%. What’s interesting is that this is the highest percent positivity rate we have had among all emergency department patients since early February. However, we’ve seen a slight drop in the number of patients who are placed in our COVID isolation protocol in the ER and among the patients who require COVID isolation, we’ve seen a drop in the percentage who are admitted compared to recent weeks. Despite this, we have more patients hospitalized with COVID now than we did a few weeks ago. We are far from our peak numbers, but COVID hasn’t disappeared and certainly BA.5 seems more contagious than previous variants and our antibodies (whether from natural immunity or vaccination) are not as protective against it.
If I am reading my COVID dashboard at the hospital correctly, we have also crossed a pretty big milestone. We have discharged more than 5100 cases of confirmed COVID from the emergency department. The hospital has also discharged approximately 4900 confirmed COVID patients who required admission/observation. Between the emergency department and the hospital, we have taken care of more than 10,000 COVID patients. This seems like a huge milestone.
In an article published online in JAMA by the CDC and colleagues this week, scientists tried to estimate the benefit of vaccines in America. I wrote about the benefit of vaccines around the world recently but here is the American data. “From December 2020 through September 2021, COVID vaccines were estimated to have prevented about 27 million infections, 1.6 million hospitalizations, and 235,000 deaths among US adults.” That is amazing. Most of the hospitalizations and deaths that were prevented were in adults 65 and over. The 50 to 64-year-old age group also benefited with 525,000 hospitalizations and 66,000 deaths prevented.
Vaccinations will remain a critical tool to help prevent morbidity and mortality going forward. Many people are eligible for a booster right now and for a variety of reasons are not getting it. At least some people are holding out for an updated vaccine that is expected this fall. These are really important conversations to have with your doctor about understanding your risk of illness now if you are to contract COVID and how much benefit a booster may help you now. With that said, boosters are generally being recommended in the 4 to 6-month range from the last shot. It is certainly possible that you could get a booster this week and then get the updated booster this fall when it becomes available. My personal take is that there is some psychology around the booster recommendations and the CDC is worried that people will get booster fatigue. Meaning, while healthcare workers will generally get boosters frequently, many people don’t want to get more than one a year (like an annual flu shot). Too much push to get a booster now, then could mean some portion of the population will be less likely to get a booster this fall, when it probably matters more (more indoor activity and cold/flu season). I’ve been asked a few times recently about getting a booster now versus waiting until the fall. Your doctor can help answer that question, I will say that my wife got her booster recently and I do expect her to get another in the fall if it’s recommended.
On a non-COVID note, there was a long thread this week on an ER doc social media platform about what to do if our own kids are choking. It turns out more ER docs than I would have expected have given their own young children Heimlich maneuvers. I definitely remember being paranoid about that and cutting up hot dogs and grapes when my kids were little (and then not so little). Because this was a group of ER docs, there were even comments about very advanced airway management techniques. At the very least, everyone should know the Heimlich and the different approaches based on the age of the person choking. If you’re unsure, please take a few minutes to read about it online.
Coronavirus is not done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.