Experts from USF Health talk COVID trends in Hillsborough, across country

With cases of COVID-19 on the rise and hospitalizations nearly doubling nationwide in the past three months, many are wondering what’s happening with COVID. 

To help make sense of this latest chapter of the virus, Hillsborough County Medical Association (HCMA) President Dr. Eva Crooke moderated the organization’s ninth town hall discussion on COVID on July 20 with a panel of epidemiology and infectious disease experts from the Florida Department of Health in Hillsborough County and the USF Health Morsani College of Medicine. The panel included:

    - Dr. Douglas Holt, Director of the Florida Department of Public
      Health in Hillsborough County;
    - Dr. John Sinnott, Chairman of the Department of Internal
      Medicine at the University of South Florida Morsani College of
      Medicine;
    - Dr. Margarita Cabrera-Cancio, affiliate professor, Department
      of Internal Medicine at the USF Morsani College of Medicine;
    - Dr. Kami Kim, Director of the Division of Infectious Disease and International
      Medicine, Morsani College of Medicine.
 
Here are key topics the panel examined. 

New COVID cases rising

Much of the recent surge in COVID can be attributed to the easy transmissibility of the latest omicron subvariant, known as BA.5, which is now the dominant strain of the virus. 

Florida Department of Health in Hillsborough County Director Dr. Douglas Holt reported that “as far as illness and severe disease in Hillsborough County, we’re seeing lower patient severities in this fourth wave of the virus.” 

“We’re now seeing about 650 cases a day, which we know is an underestimate since there is now less testing being done,” Holt said.
 
Holt stated hospitalizations in Hillsborough County are currently running about 30 patients per day, slightly up from a low of 10 per day in April. 

Morsani College of Medicine Director of the Division of Infectious Disease and International Medicine Dr. Kami Kim said there’s less severe disease with this variant, in part because many people have some protection either from vaccination or from having COVID already. 

“The problem is with people at increased risk, such as the elderly and those with serious medical conditions like heart disease or cancer,” said Kim, who is also the director of research at the Global Emerging Diseases Institute that USF Health and TGH launched in collaboration in the wake of COVID.

Concerning the BA.5 variant, the panel agreed on two things: it appears less deadly than prior variants and vaccination is by far the best way to avoid hospitalization or worse. Where hospitalization rates have increased in the past three months in Hillsborough County and much of the U.S., most cases are among unvaccinated patients. What remains unclear is the potential for long COVID symptoms that, in a low percentage of patients, may persist for months and may cause chronic fatigue, “brain fog” and other debilitating symptoms.

Holt said Hillsborough County’s 70 % vaccination rate was “not bad,” but “hasn’t moved an inch in recent weeks.” That is consistent with a national downward trend in vaccinations.

All three of the original U.S. vaccines--Pfizer, Moderna and Johnson and Johnson--have been associated with a very small number of serious risks, including blood clots and strokes. But the chance of having any of these complications is quite low, with approximately five cases per million people vaccinated. 

These risks are slightly less with the Pfizer and Moderna vaccines, which have been preferred for that reason. A third uncommon but potential complication, myocarditis, is now known to occur mostly in males aged 18-40 for reasons not yet well understood.

On July 19, the CDC approved Novavax, the fourth U.S. COVID-19 vaccine available for adults 18 and older (see related article). Dr. Margarita Cabrera-Cancio, an affiliate professor in the Department of Internal Medicine at Morsani and the medical director at Infectious Disease Associates of Tampa Bay, noted that Novavax “is a traditional protein-based vaccine that acts by boosting the body’s immune response, which represents an effective alternative for those who have not yet been vaccinated”. 

She cautioned, however, that “studies on Novavax were done before the delta and omicron strains evolved, so we don’t know if it will prevent infection other than severe disease.” According to the CDC, Novavax will be distributed in late July but probably not be available in pharmacies and doctor’s offices until August.

Kim also indicated that a fifth vaccine specifically designed to be effective against multiple omicron variants is being developed for possible availability in the fall.

Boosters: It’s all in the timing 

Current CDC guidelines recommend one booster for everyone age 5 and older who is eligible after completing their COVID vaccine primary series. Two boosters are recommended for adults aged 50 years or older and adults who are moderate to severely immunocompromised. Kim suggested that individuals who have been eligible for boosters for at least six months go ahead and get boosted. If less than six months, she suggested they perhaps wait for the new vaccine rollout in the fall.

Home tests: are they reliable

Morsani College Chairman of the Department of Internal Medicine Dr. John Sinnott noted that at-home tests, when positive, suggest contagiousness is present. There are very few false positive tests, he said, but “with a negative test you’re not sure.” 
 
Sinnott, who is also chief epidemiologist at Tampa General, recommended performing a home test in the event of even mild symptoms because “the worst complications of COVID-19, such as blood clots and strokes, often occur within the first few days of the infection.”

Kids and COVID 

With the new school year approaching, Holt noted “you can anticipate that your child will be exposed since schools are a prime environment for transmission."

In Hillsborough schools, there will not be a mask requirement as the Hillsborough County School Board’s current policy-- aligned with the state’s support of the “parents’ rights” movement--allows parents to decide whether or not their children wear masks in school.

The panelists supported vaccinating children against COVID-19 despite the Florida Health Department’s position of recommending against it routinely in children. Florida is the first state in the nation to officially oppose this CDC recommendation.

Sinnott recalled that with polio, it wasn’t until decades following the epidemic of the 1950s that “post-polio syndrome," a neurological condition causing muscle weakness and fatigue was recognized to have afflicted a majority of these patients who had been infected years before and had since recovered. Sinnott cautions that a similar scenario could occur with COVID, adding emphatically that “children should be vaccinated”. Kim noted “vaccinating children not only protects them but also family members, especially ones at high risk like grandparents”.

Exposure to COVID: a nuanced approach

The panelists agreed the general relaxation of mitigation measures such as masking and social distancing have contributed to the recent rise in infections. They emphasized taking an individualized approach if exposed to someone with COVID. 
Ideally, after exposure avoiding contact with others should be maintained for 10 days. Sinnott spoke of “an eight-day window of contagiousness” that begins with the onset of symptoms. CDC guidance calls for isolation (quarantining) for a full five days if exposed to COVID and unvaccinated.  

Holt pointed out that the isolation of asymptomatic individuals who were exposed to the virus and unvaccinated may not be realistic in many workplace situations. In that scenario, he advised wearing a mask. 

Exposure to the virus for vaccinated individuals does not require them to quarantine but a COVID test should be done at least five days after exposure. Regardless of vaccination status, the CDC recommends wearing a well-fitting mask for the full 10 days when around others in your home or in public. Sometimes there is no clear answer as to what constitutes exposure to the virus. As a rule of thumb, Kim advised that “15 minutes is often used as a guideline,” adding “what really counts is physical proximity.”

At home treatments 

The panelists agreed that effective medications, especially paxlovid, an oral prescription medication that must be taken within five days of symptom onset, have helped reduce hospitalizations. However, up to 20% of patients cannot take the drug because of interactions with medications they are already taking. It’s best to avoid opiates when taking paxlovid as the drug causes blood levels of opiates to rise. 

Kim emphasized the importance of early treatment in preventing hospitalizations. In offering practical therapeutic advice to his physician audience, Sinnott mentioned that he asks all his non-hospitalized patients to purchase a humidifier and an oximeter to help manage their illness. It is important, he noted, “to drink plenty of fluids as the BA.5 variant tends to take away thirst and patients become easily dehydrated.” 
Sinnott offers Listerine for the bad taste that sometimes accompanies paxlovid, non-prescription Flonase for sore throat and cough and alternating aspirin and Tylenol for pain relief.

“Patients don’t come in to see us to get rid of the virus,” he said. “We treat the symptoms."
 

Read more articles by Dr. Bruce Shephard.

Dr. Bruce D. Shephard, a retired Obstetrician-Gynecologist and Affiliate Associate Professor, Department of Obstetrics and Gynecology, USF Morsani College of Medicine, is best known locally for delivering more than 7,350 babies. He now occasionally teaches and always practices good health, dabbles in writing, and raises monarch butterflies. He and his wife, Coleen, live in Tampa.