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!
Prior to the pandemic, I generally wore a dress shirt and tie on my administrative days. One of the best parts of the pandemic is I can count the number of times I’ve worn a tie in the last 3 years on one hand and I’m typically in a scrub top five days a week. This week was administratively heavy and required a shirt and tie three days. I had some bosses in town for a couple of days of meetings, had a couple of nights of work dinners, and had an introductory meeting about ED renovations. Needless to say, I’m happy it’s Friday.
Because of the heavy admin week, I only worked one clinical shift and it was Tuesday. It was busy, I admitted about half my patients, and I don’t believe I saw anyone with COVID. What’s interesting to me is that the week has been so busy, I don’t remember the details of the shift as well as I typically do.
It’s probably not a surprise, but if I see colleagues around the hospital, I frequently get asked how the ER is going. Based on my last shift, I would say that COVID is way down.
It’s interesting to me that the new variant XBB.1.5 is now making up the majority of cases around the country and is considered much more transmissible than previous variants. Yet based on my last shift and looking at our tracking board, I would say COVID was still improving compared to previous weeks. And then there’s the data. We had a small increase in the number of patients who required COVID isolation this past week and saw a 20% increase in the number of patients we diagnosed with COVID. We’re still about 20% below our late December peak, but we had dropped 38% as of last week. Is this the new variant coming into the area? I don’t know yet. Although the hospital is quite full, the number of patients with COVID is similar to last week and we are rarely seeing bad COVID pneumonias and respiratory failure these days. They occur but it’s not a regular occurrence.
It really is amazing how quickly misinformation spreads through social media. If you’re on Twitter, you probably saw videos of people who claim to have developed seizures and/or muscle spasms related to the vaccine. I read that it occurs in 7% of all patients who get the vaccine. Fortunately, over and over on Twitter, doctors tried to get the truth out. I have seen tons of vaccinated patients and not once has any patient come in for spasm like activity attributable to the vaccine. The 7% is a made up number.
I was at a dinner this week with an assortment of highly educated people. (I’m intentionally being vague as to the guest list). One of them stated that ERs are being overrun with volume because of vaccinated patients coming in as a result of myocarditis and blood clots. This also is not true. When he responded by saying he was hearing this from people who run the ERs, my colleague assured him that he was talking to three people who run ERs and none of us are seeing this.
In the end, I do believe the science wins and there were some good articles this week that support the safety and efficacy of vaccination.
From the CDC’s MMWR this week, the bivalent booster is proving to be effective against BA.5 and the new variant XBB.1.5. “The updated vaccine helped prevent illness in roughly half of the people who had previously received two to four doses of the original COVID-19 vaccine, CDC said.” The findings showed the bivalent vaccine “was 52% effective at preventing infections against BA.5 and 48% against XBB/XBB.1.5 among those aged 18-49,” but “effectiveness fell to 37% against BA.5 and 43% against XBB/XBB.1.5 among those aged 65 years and older.” Only about 40% of adults 65+ and only 16% of those 5+ have received the latest COVID booster. A lot of our population can still benefit from it, and certainly those over 65 or other risk factors.
There was a very large meta-analysis published in JAMA Pediatrics this week reviewing the efficacy and safety of the COVID-19 vaccine in children 5-11 years old. The meta-analysis included 17 studies with 10,935,541 vaccinated and 2,635,251 unvaccinated children. This is a huge review. Vaccination was shown to be associated with “lower risks of SARS-CoV-2 infection, COVID-19–related illnesses, and hospitalizations due to COVID-19–related illnesses.” This means less infections, symptoms, hospitalizations, and MISC. Adverse reactions from the vaccine were quite common (pain, fever) and were generally mild and were more common for the vaccine compared to placebo. The risk of myocarditis was 1.8 cases per million vaccines after the second dose. For perspective, the risk of developing myocarditis after having COVID is higher than the risk of getting COVID from the vaccination. An Israeli study showed that the “risk of developing myocarditis following SARS-CoV-2 infection was 18 times higher than the control group, while it was 3 times higher following vaccination than the control.” My kids are vaccinated. Ultimately, the most important line for parents to read and think about from the authors is the following: “vaccination was associated with lower risks of SARS-CoV-2 infections, severe COVID-19–related illnesses, and hospitalizations due to COVID-19 and (2) while mRNA COVID-19 vaccination compared with placebo was associated with any AEs, most of them were non severe and transient.”
We’re going to hear a lot more about vaccines over the next few days. The FDA Vaccines and Related Biological Products Advisory Committee met yesterday to review recent recommendations that COVID vaccines become an annual event, like a flu shot. It may be twice a year for immunocompromised people, young children, and older adults but for most people, annually will be the way to go. It’s likely the original formula will be phased out and the bivalent vaccine would be used for the first series of doses as well. Like the flu shot, it’s possible the fall dose will be based on the most likely variant circulating in the spring.
Coronavirus is not quite done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.