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 posted on his Facebook page ever week!
Friday Night Update from the ER in Arlington, VA
It’s been a hectic week and time has run short for me to write my Friday night update, so let me see if I can jump into the highlights.
The COVID numbers generally continue to improve. The number of patients who require hospitalization is a touch below last week. The number of patients that we put on our COVID isolation status in the emergency department, is also less than the last few weeks. This number has been trending down for about 6 weeks. We still have a ways to go before we get to the trough we experienced in September but we are headed in the right direction. The number of patients we tested in our symptomatic cohort has been relatively stable the last several weeks. The number of positives, or the percent positivity rate, has waxed and waned a little bit but is generally within a couple percentage points week after week. I do not report our general screening numbers very frequently, but the data was pretty interesting this past week. We generally screen about 500 patients a week. A large number of these are for patients who require admission but are not symptomatic with COVID. We just want to keep staff safe by knowing if they have it or not. Some of these are patients who are being evaluated for an illness that we do not think is COVID. Either way, these patients generally do not have cough, fever, shortness of breath, or other things that we would associate with COVID. Our 6-week running average has been pretty stable at about 10% for this patient population. However, we have seen a decline in the percent positivity, as well as the actual numbers of patients that are testing positive over the last couple of weeks. There has run about 10% for the last several weeks ago but this past week was 6.2%. Because of these numbers, we also saw a drop in the total number who tested positive this past week and the overall percent positivity rate for the entire emergency department population.
With that said, I took care of a handful of patients this week who were known to be COVID-positive prior to coming to the emergency department. Depending on where and when these patients were tested, we may not retest them. Therefore, they would not be included in much of the testing data (though are included in the “covid isolation” data). These patients came in for a variety of things but were generally pretty sick and required admission. Some had low oxygen levels that could be related to pneumonia or blood clots. Another patient had profound dehydration with damage to her kidneys.
Although COVID numbers are generally improving, there is still plenty of people who get quite sick and require hospitalization.
Scientists are still trying to find the best way to reduce the morbidity and mortality associated with COVID. Published this week in the NEJM, scientist looked at the use of interferon in the outpatient setting for patients diagnosed with COVID. Endpoints were looking at hospitalization and death. Interferons are proteins that cells can release to fight viruses. Interferon has been used through the years to treat hepatitis, malignant melanoma, and Kaposi sarcoma. Interferon lambda was used in this study and was developed in 2003. This was a randomized controlled study that looked at 1951 participants from Brazil and Canada, most of whom were vaccinated and diagnosed with COVID in the outpatient setting. The primary outcome was hospitalization or a prolonged emergency room visit for COVID and it was found that patients in the interferon group had a 50% lower rate. Death from COVID was also lower in the group of patients who received interferon. Interferon seemed to benefit the patient whether they were vaccinated or unvaccinated. Side effects from interferon have historically been pretty bad, but in this particular study, side effects were generally mild. Monoclonal antibodies are not effective for the current variants of COVID. Paxlovid is taken by mouth, is effective, and definitely has a role in preventing downstream consequences in a subset of patients. Further treatment options would be beneficial. At this point, the FDA has not recommended or approved interferon for emergency use authorization for patients yet. But it is something to look out for.
Published in the MMWR today, is a study looking at mortality differences between unvaccinated and vaccinated people and the impact of the bivalent booster. For patients “age 12 and up, vaccinated people who received an updated COVID-19 vaccine are 14 times less likely to die compared with those who received no vaccine and 3 times less likely to die compared with those who received only the original COVID-19 vaccine.” The studies show that adding in the booster, gives significantly higher protection against death as well as slightly higher protection against infection.
I hope all of you have had a chance to enjoy the springlike weather the last couple of days. Enjoy your weekend. See your friends and family. Stay well. Oh yay, there’s a football game Sunday, too.
Coronavirus is not quite done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.
Mike
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