Thanks as always to 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
I continue to have friends who are getting COVID for the first time so it’s clearly around. However, our numbers show some improvement for the first time in weeks. The number of new COVID cases we diagnosed in the ER fell to its lowest level in a month and is 15% less than last week. Our percent positivity rate also fell from 13.8 to 11.8% over the last few weeks (6 week average of 12.5%). Although the number of patients currently hospitalized remains similar to last week (this number usually falls a few weeks after new diagnoses fall), the number of patients who required our “COVID isolation” protocol fell for the first time in 3 weeks. The number of these patients who required admission is down 20% from last week.
I was with a friend recently who was on day 7 of COVID. Per CDC guidelines, he was still in a mask and told me his rapid tests were still faintly positive. And I definitely appreciated that. In a new study published online in JAMA, it looks like most patients with COVID-19 “continue to test positive past the CDC’s five-day isolation guidelines, but only half of them are actually contagious, a small study…found.” Scientists took previously healthy patients and correlated their rapid antigen tests and clinical symptoms after day 5 to viral cultures (the best way to determine transmissibility—this is a lab test for research and not one done in the clinical setting). Everyone who had a negative RAT has a negative culture and all patients had a negative RAT by day 14. This was a small study with only 40 patients but does have some good news. If your RAT is negative, you are likely not at risk of transmitting virus. I would still follow the CDC recommendations to isolate for the first 5 days after a positive test and then wear a mask day 6-10.
Most of you have probably heard about the rebound risk of taking Paxlovid, which happened to President Biden. Now, a study has come out that “found that 27% of people with COVID saw a rebound in their symptoms after they had initially improved.” In addition, this study “found that 12% of people with COVID had a ‘viral rebound,’ meaning they tested positive again several days after testing negative.” Again, kind of a reason to mask through day 10.
Yesterday, Monkeypox was declared a public health emergency in the US. There are now 7000 cases in the US, including 2 in children. The risk of severe disease is increased in those who are immunocompromised, age <8, those with exfoliative skin conditions like eczema, and pregnant or breastfeeding women. It is primarily spread through close, personal, often skin to skin contact with someone who has monkeypox. It can be passed via secretions and respiratory droplets (prolonged face to face contact like kissing or cuddling). It is possible for the virus to be spread via contaminated towels and bed linens as well as shared utensils. Scientists are still figuring out transmission. Earlier today, it was reported that a daycare worker in Illinois tested positive for monkeypox with multiple children reportedly exposed. Monkeypox is not as transmissible as COVID thought the local health department will be tracking those exposed. It seems unlikely that monkeypox is transmitted via non-porous surfaces, but I think we’ll know more over the next month. For us in the ER, PPE is similar to COVID, with gown, gloves, N-95, and eye protection. Fortunately, so far, there have been no deaths related to monkeypox.
Coronavirus is not done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.