January 2022 - COVID-19 Update
Dr. Joel Weisblat • January 4, 2022
JANUARY COVID UPDATE
January 23, 2022
As we close in on 2 years into this pandemic, there are hopeful signs for the future. Here are my latest thoughts:
1) Although Covid case numbers remain high, and in some areas are still rising, the numbers in Cuyahoga County are down substantially from a few weeks ago.
2) The vast majority of cases right now are due to the omicron variant, which is significantly more contagious than all previous variants, and which evades the vaccine at about a 50 percent rate.
3) Fortunately, those who have been vaccinated (and particularly those who have received a booster) are dramatically less likely to suffer severe illness from omicron. Deaths from Covid occur 20 times more often among the unvaccinated.
4) Initial vaccination increases the antibody response to Covid, but the booster dose also stimulates a strong B- and T-cell response, which is critical in preventing deeper infection.
5) This B- and T-cell response tends to be longer-lasting than the antibody response, which means that the booster is likely to retain effectiveness over time, even against the omicron variant.
6) Treatment of Covid infection is changing, as the monoclonal antibodies that were effective against delta and other variants are not effective against omicron. The good news is that a new antiviral drug has been approved for use in certain patients, and appears to be safe and effective.
7) It does not appear likely that a fourth dose of the vaccine will be necessary any time soon. However, it is possible that a reformulated vaccine (and perhaps boosters) will be recommended in the future.
8) As long as case numbers remain high, the key to staying safe is the same as ever: avoid crowds, wear a mask indoors, keep your distance from others, and limit close contact to a small circle of people. And of course: complete your vaccination, including the all-important booster shot.
9) There is reason for hope, as the trends around the world suggest omicron tends to infect susceptible individuals quickly and then recede. If that holds true here, cases should drop further in the coming weeks, resulting in a much lower risk of infection. Unfortunately, until more people are fully vaccinated, this virus will likely stay with us yet for some time.
10) These past 2 years have been exhausting, but things are getting better. Please reach out to us with your questions and concerns, and we’ll do our best to help you through it.
Joel D. Weisblat, M.D.
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Dear Patient: There has been a lot of news about the pandemic in recent weeks, and also a lot of confusion. Today’s update is in the FAQ form, in response to many of your concerns. 1) What is the current state of the Covid-19 pandemic? Obviously, it isn’t good, but there may be reason for optimism. The number of cases nationally seems to have plateaued, albeit at a high level, and the number of people vaccinated is steadily growing. Unfortunately, in Ohio, things are likely to get worse before they get better. Case numbers in the state are averaging above 4000 daily, higher than in many months. 2) What can I do to protect myself from infection? The same things we’ve been recommending all along. Wear a mask indoors in public places, keep your distance from those who may not have been vaccinated, and of course, if you haven’t been fully vaccinated, get it done today. 3) I thought the vaccines were effective, why are people talking about boosters? The Pfizer, Moderna and J&J vaccines have all proven to be quite effective at preventing serious Covid infections. However, we are seeing some waning immunity after 6 months, which is leading to a number of “breakthrough” cases. The good news is that the vast majority of these cases are mild or asymptomatic, with no more than a few days of illness. Even 6 or 8 months after completing vaccination, you remain very unlikely to contract a serious Covid infection. 4) What is a booster shot? Should I get it, and if so, when? A booster is just another dose of the vaccine, no different that the ones you already received. It is designed to further enhance the immune system’s ability to combat the Covid virus should it enter your body in some way. The CDC currently recommends a 3rd dose of Pfizer or Moderna in those who meet their strict definition of immune compromise, or (beginning Sept. 20) in those who are 8 months out from their 2nd dose. No recommendation regarding J&J boosters has yet been made. 5) Aren’t there drugs now that can treat Covid? Two drugs have been approved for treatment of SARS-Cov-2 infections. Remdesivir is an antiviral medication that has been shown to reduce mortality and length of stay in hospitalized patients. Regeneron has created a cocktail of monoclonal antibodies (REGEN-COV), which directly attack the virus, and it has been approved for use in Covid-positive patients who are not seriously ill, and in some cases for prophylaxis. Hydroxycholoroquine (an antimalarial drug) and ivermectin (an antiparasitic drug) have not been shown to be of any benefit in fighting Covid, may in fact be dangerous, and should not be used under any circumstances. 6) What do I do if I have been exposed to Covid? A vaccinated person exposed to Covid does not need to quarantine, but should get tested several days after exposure. Vaccinated individuals who are positive do not shed as much virus as unvaccinated individuals, and so are unlikely to transmit the virus to other vaccinated individuals. Nonetheless, those who are unvaccinated or otherwise at high risk for serious Covid infection may be eligible for prophylactic monoclonal antibody treatment. 7) Where can I get treated? If you meet the criteria listed above, you are a candidate for the Regeneron cocktail. Please call the office and we can confirm your eligibility, order the injection, and direct you to a facility where you can receive it. 8) Is this ever going to end? Yes. One-third of Americans have now been infected with Covid, and over 60% of the eligible population has been fully vaccinated. This means that the pool of susceptible individuals is shrinking every day. We will reach a point where there simply aren’t enough susceptible individuals to sustain community outbreaks. The sooner people get their vaccines, the more they wear masks in risky settings, the sooner we will reach that point. Most experts believe that by early next year the virus will no longer be a serious threat in most areas of the country. 9) What can I do to do help? Encourage your friends and family who are reluctant to get vaccinated to get their shots. Keep wearing your mask indoors and practice social distancing. Let us know if you are feeling sick, so we can guide you to the appropriate treatment. And don’t despair! There is a light at the end of the tunnel. Joel D. Weisblat, M.D.
August 1, 2021 As the Delta variant roars through the country, some things have changed, and some have not. Here are my latest thoughts: 1) The resurgence of Covid-19 throughout the U.S. is real, and Ohio is starting to feel the brunt of it as well. Daily cases in the state are averaging over 1000, a five-fold increase in recent weeks, and hospitalizations and deaths are on the rise as well. 2) The reasons for this increase are threefold: the Delta variant is up to 5 times more contagious than previous variants; large numbers of Americans remain unvaccinated; and people are for the most part not wearing masks. 3) The very good news is that the vaccines seem to be holding up well, particularly the mRNA vaccines (Pfizer and Moderna). Those who have been vaccinated are much less likely to contract the virus, and if they do get infected, are dramatically less likely to get quite ill. It is estimated that less than 1 percent of those currently hospitalized with Covid were vaccinated. 4) Much has been written in recent days about the potential of vaccinated individuals to infect others, but what hasn’t always been reported is that those who are getting infected in this way are almost all unvaccinated. It still appears that vaccinated individuals without symptoms can congregate indoors with very little risk. 5) I think the most important message today is to re-emphasize the importance of wearing masks indoors. Most outdoor settings are safe, but the risk of transmission indoors is high, particularly when one doesn’t know who’s vaccinated. Wear your mask, maintain social distancing, and try to avoid crowds. 6) I would still recommend people avoid indoor restaurants, and the safety of plane travel is an open question with cases on the rise and mask requirements in flux. 7) Another question is whether an additional dose of vaccine will be necessary. There is conflicting data here, but I suspect we will be recommending people to get another dose in the coming months. Immunity does likely wane over time, though there is no evidence that fully vaccinated individuals are unprotected after 6 or 7 months. 8) Finally, I implore those of you who are not yet vaccinated to do so now. Covid can wreak havoc on your health, even if you are not in a high-risk category, and the contagion of this variant makes it much harder to avoid than the previous ones. Please contact me if I can answer any questions you may have about the safety or efficacy of this vaccine. 9) A hopeful bit of news is that the number of people getting vaccinated has picked back up, and if that trend continues, we may yet be free from this pandemic in 2022. Stay safe! Joel D. Weisblat, M.D
July 6, 2021 Dear Patient, As we attempt to get our lives back to normal after months and months of restrictions, I want to urge everyone to stay cautious. Here are my latest thoughts: 1) The 7-day average of new Covid cases in Ohio has dropped close to 250, and in Cuyahoga County we are seeing only 25 new cases per day. These are easily the lowest numbers we have seen since the earliest days of the pandemic. 2) Unfortunately, the news is not good everywhere. The number of cases nationally is ticking upwards slightly, attributable to the spread of the more contagious Delta variant, most notably in regions where the vaccination rate is low. 3) Studies indicate that being fully vaccinated against Covid, either with the single-dose J&J vaccine or the 2-dose Pfizer and Moderna vaccines, provides strong protection against contracting Covid, and very strong protection against serious Covid infection, even in the face of the Delta variant. 4) I urge everyone who has not yet been vaccinated to do so as soon as possible. If you have concerns about the safety of the vaccine or question whether or not you really need it, please reach out to me. This virus remains a very serious threat for the unvaccinated, and failure to get vaccinated puts you and those around you at much risk. 5) Although the risk of getting sick is quite low for the vaccinated, it is not zero, and I recommend a little more caution at this time than does the CDC. I advise continued mask wearing indoors when around others who may not be vaccinated, particularly in crowded areas or when you anticipate more than a few minutes of potential exposure. 6) There is no need to wear a mask outdoors, except perhaps in very crowded spaces. The risk of outdoor transmission is quite low, particularly if one has been vaccinated. 7) All 3 Covid vaccines available in the U.S. have shown sustained immunity to the virus, so there is unlikely to be a need for boosters before next year at the earliest. The biggest concern is that a new variant will develop which evades vaccine-mediated immunity. Fortunately, there is no indication that this has occurred to date. 8) The best news I can offer for the vaccinated is that it is perfectly safe to interact indoors with others who have been vaccinated. No masking or social distancing is necessary. 9) I hope you were all able to enjoy this holiday weekend without the fear that has plagued us for months. With any luck, our numbers will stay low and life will indeed be close to normal for the foreseeable future. 10) Please give us a call with any questions. We are fully back in the office, and welcome those who have been away to schedule a visit and let us help you stay healthy going forward. Joel D. Weisblat, M.D.