WILLIAM A. PETRI special for daily progress
A message to readers from Dr. Bill:
Recent CDC guidance easing COVID-19 restrictions marks a significant turning point in the pandemic. I expect that in the next few weeks in Central Virginia, we will no longer need to mask in indoor public spaces. While this is great news, we should be aware that the guidelines may change again if a new variant emerges, and that we should be respectful and careful of immunocompromised people. But mostly, I thought it might be a time, especially with the two-year mark approaching, to note where we came from.
It’s hard to remember the dismay felt in late February 2020 when the first cases of COVID-19 in the United States were recognized at a Life Care nursing home in Kirkland, Washington. The terrible toll there was quickly followed in March by the cataclysmic pandemic in New York. It was clear that Charlottesville would not be spared, but luckily we had been warned. Providentially, the South Tower of UVa Hospital was nearing completion in February 2020. It was a new emergency department with significantly expanded space for the isolation and care of those suspected of COVID-19, and a beautifully designed space for those ill enough to require hospitalization. The construction team was able to rush the opening of rooms 5 and 4 south for COVID-19 until March, and even design the ventilation of the rooms to be “negative pressure”, preventing infectious virus aerosols to spread in the corridors. On the heels of the opening of the South Tower, the first diagnostic test in Virginia was performed. This effort was led by Amy Mathers, who despite supply chain issues, developed a PCR test, with research professors at UVa contributing reagents and PCR machines normally reserved for molecular biology research. Doctors, nurses, respiratory therapists and more have volunteered to care for patients with COVID-19, which before the vaccine put them at great personal risk. I remember one of the fellow infectious disease doctors I worked with told me that he read bedtime stories to his 4-year-old daughter through a closed bedroom door, so as not to expose her potentially if it were to be infected!
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Most importantly, the people of Charlottesville, in part through their participation as subjects in clinical trials, have contributed to the scientific advances that have brought us to this turning point. This included the findings that anti-spike monoclonal antibodies prevented and antiviral agents helped cure COVID-19. I will never forget the critically ill COVID-19 patients in 5 South telling me they wanted to be part of a study of a new treatment to “help the next person.” I, and all of us really, owe a deep debt to these selfless people, a debt that we can only pay by helping others in need.
As a community, we have also contributed to ending the pandemic as taxpayers through our support for research at universities and the NIH. The pace of discovery is far beyond anything I have seen in my 40 years as a physician and scientist. Vaccines and treatments appeared seemingly overnight, but only because decades of prior biomedical research taught us how to vaccinate against coronaviruses and design antiviral drugs.
So as we move in the coming weeks from the current high levels of transmission to a slower pace of new infections that allows for unmasking, we are in a much stronger position should COVID-19 return as a pandemic or outbreak. ‘epidemic. Vaccines, masks, home diagnostic tests and pills currently freely available protect us all. However, not for a moment should we ignore the fact that better treatments and vaccines for children are desperately needed.
I hope years from now we will look back on those times and reflect on the contributions of the health care providers and scientists who volunteered when we needed them most.
1. Question: Are we really safe now?
Answer: Excellent question! I remember Mary Ann and I years ago house hunting and found something that seemed too good to be true. I asked our realtor if the house was in a safe neighborhood (it was in Cleveland) and she said “it’s right next to a safe neighborhood”. All kidding aside, we’re much safer than we’ve ever been. It’s not just because of the precipitous drop in omicron cases worldwide, but because of vaccines that decrease our risk of hospitalization by 10 times, antiviral pills, and widely available diagnostic tests.
2. Question: Why are we loosening everything but the number of cases is still higher than last August?
Answer: You are correct that in Central Virginia we should not be easing things yet, as we are lagging behind most of the country and we are still at a high level of transmission. I expect this to change in the coming weeks so that we are at a low enough level to allow unmasking in indoor public spaces. You can view the rate of new infections for Virginia locations on the CDC’s new “COVID-19 Community Levels” transmission site: https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html The CDC site takes into account not only cases of new infection, but also local hospitalization levels, to better assess levels of serious infection (incidentally, the UVa hospital went from more than 100 to less than 40 patients with COVID-19 this week).
3. Question: I heard about a new sub-variant related to Omicron. Can this turn into a dangerous epidemic?
Answer: Omicron’s BA-2 subvariant seems to be more transmissible than the original. It currently accounts for about 8% of all COVID-19s in the United States (the remaining 92% is the original omicron variant called BA-1). Its prevalence doubles every week and could eventually replace BA-1. Its surge is occurring, however, as overall COVID-19 cases have fallen by 90%, so it does not appear to threaten to cause another pandemic wave.
4. Question: I talk to a lot of people who have had COVID-19, and they still have a variety of weird symptoms. Is there really something called long COVID-19, and how is it treated?
Answer: Most people fully recover from COVID-19. However, in a minority, there is clearly a problem with ‘long COVID-19’, which may include shortness of breath, cough, fatigue, change in smell or taste, joint or muscle pain or fever . The long COVID strikes me as most likely due to the immune system imbalance caused by the virus, with evidence that this imbalance is sometimes not restored for weeks or even months. This is an area of intensive research but with no proven treatments yet.
5. Question: Please explain the VAER data that people who seem to me to be conspiracy theorists keep quoting. For example, did tens of thousands of people die within three days of vaccination?
Answer: The Vaccine Adverse Event Reporting System, or VAERS, is a database maintained by the CDC and FDA to collect data on any symptoms following vaccination that may be due to a side effect of the vaccine. VAERS helped uncover the rare blood clotting problem associated with the J&J vaccine, and the equally rare problem of myocarditis in mRNA vaccine recipients. Misuse of VAERS occurs when data about the problem in vaccinated people is not compared to a control population that did not receive the vaccine. In the example you cite, since 1 in 100 Americans die each year, when 250 million Americans are vaccinated, a small percentage will die after receiving the vaccine and will be reported in VAERS, even if the vaccine is not responsible for these deaths. I appreciate you asking this question, as misinformation prevents some from being vaccinated, including a member of my extended family who tragically died of it.
6. Question: A year of questions and guesswork about the COVID vaccine has made me wonder if I understand vaccines in general. We seem to accept that the COVID vaccine doesn’t necessarily prevent us from getting COVID, but it does prevent us from getting fatally sick with it. Does that mean I could get tetanus if I step on a rusty nail, but it won’t make me very sick? I thought the purpose of the vaccines I received was prevention, but I could be wrong. Is the difference in the quality of the vaccine or in the attributes of the pathogen?
Answer: The purpose of vaccination is to prevent disease but not necessarily infection. The tetanus vaccine is a great example, where the vaccine works to neutralize tetanus toxin from causing lockjaw but has no impact on preventing infection from the bacteria that makes the toxin. The Pfizer and Moderna vaccines are up to 90% effective in preventing hospitalizations from COVID-19, but much less effective in preventing infection.
7. Question: I recently read that vaccines have proven to be less effective than scientists had hoped. I guess it was in response to the omicron contagion. But from what I understand, the vaccines have been extremely effective and would have been more so if more people had received them. So, was the omicron contagion a vaccine failure, the result of fewer vaccinations than we would have liked, or a bit of both?
Answer: A bit of both. The omicron variant has so many mutations in the viral spike protein that it was able to partially escape the immunity provided by vaccination or previous infection with other variants. Fortunately, vaccines are still very effective at preventing hospitalization, probably by inducing a strong cell-mediated immune response that can cure the infection once it has started. Tragically, about two-thirds of people hospitalized at UVa with COVID-19 have not received the vaccine.
8. Question: Charlottesville is still considered high risk, so why is it safe to be maskless? What do you advise people about wearing a mask?
Answer: I advise everyone to be patient and stay masked in indoor public spaces until we move from high to low transmission, probably later this month!