In just over two years, COVID-19 has resulted in 876,000 U.S. deaths including over 64,000 fatalities in Florida. While numbers of the Omicron variant appear to have peaked this month (January 2022), concerns and confusion about “what’s next” is on the minds of many.
Wednesday night, the Hillsborough County Medical Association conducted its eighth virtual Town Hall on COVID-19, with local experts from the USF Morsani College of Medicine and the Hillsborough County Health Department providing updates reflecting our current knowledge about the pandemic and how it is impacting Hillsborough County.
- Dr. Margarita Cabrera-Cancio, Affiliate Professor at the University of South Florida Morsani College of Medicine, Department of Internal Medicine;
- Dr. Doug Holt, Director of the Florida Department of Health in Hillsborough County;
- Dr. Charles Lockwood, Senior VP for USF Health;
- Dr. Joel Silverfield, President of the Hillsborough County Medical Association (HCMA);
- Dr. John Sinnott, Chair, USF College of Medicine Internal Medicine.
Below are some of the key points the panelists addressed to a mostly physician audience.
Decreasing number of cases --
Dr. Holt reported that last week’s 2,000 new cases of COVID-19 in Hillsborough County (Tampa) actually represented a 38% decrease from the week before. He noted “while the impact on the hospital system has been a big challenge, our health care has risen to that challenge.” Vaccination rates are “somewhat disappointing,” he said, with 64% of the county’s population having received at least one dose and only 18% fully vaccinated including a booster shot. Overall, in the U.S., he added, “our public health system is hurting and has experienced a 40% decrease in funding going back to the Great Recession in 2008.”
Tests: Antigen vs. PCR
-- The panelists did not specify a preference for a particular brand among the many antigen-based home tests. Dr. Cancio noted “antigen tests are good predictors if you are sick and the tests correlate well with infectivity.” Antigen tests also have been used as a guide for determining after a COVID-19 infection when you are no longer infected, which is signaled by a negative antigen test. All tests can have a few false positive or negative results, she cautioned. The PCR test is done mainly to confirm the diagnosis of COVID-19 and may remain positive for several weeks or more.
Managing exposure to COVID-19
-- The CDC has recently produced a complex algorithm which the panel succinctly summarized as follows:
What to do if you test positive for COVID-19
- Those who have been fully vaccinated and are without symptoms don’t need to quarantine but should wear a mask in public spaces for 10 days and be tested 5 days after exposure.
- Unvaccinated persons exposed to the virus should quarantine for 5 days according to the CDC and get tested on day 5 as well as wearing a mask around others for 5 more days. Dr. Holt quipped, “if vaccinated, assume you are uninfected, and if unvaccinated assume you are infected and infectious.”
-- Anyone testing positive, regardless of vaccination status, should isolate for 5 days. Then, if you have no symptoms or your symptoms are improving, you can leave your house after 5 days but should wear a mask around others for 5 more days. Panel members emphasized anyone with risk factors like high blood pressure or diabetes, who are immunocompromised, or have worsening symptoms -- especially high fever or shortness of breath -- should contact their physician promptly.
-- These have been used to treat COVID-19 either before or after the onset of symptoms but are now in short supply in Hillsborough County, according to Dr. Holt. Last week, the FDA revoked two of three available monoclonal antibody treatments as they were found “highly unlikely” to be effective against the Omicron variant. Immediately after, the Florida Department of Health shut down all statewide monoclonal antibody treatment centers. The two ineffective therapies, Regeneron and the one by Eli Lilly, are no longer available in Florida, although, sotrovimab, made by GlaxoSmithKline is still available but in limited supply.
Current medical treatment for COVID-19
-- Dr. Sinnott noted the first thing he does is to have his patients take a baby aspirin daily because blood clots can be among the earliest severe, if uncommon, effects of the virus. He utilizes either Pfizer’s Paxlovid or Merck’s Molnupiravir but cautions these drugs have risks and side effects and “are not for everyone.” Given within a few days after infection, these 5-day oral regimens reduce hospitalizations by 90%. He often utilizes Tylenol, a humidifier, viscous lidocaine and encourages fluids as most patients are dehydrated. A home oximeter to measure oxygen levels is important as well.
On masking best practices
-- The type of mask and how it is worn is important. Dr. Cancio noted that cloth masks “are not as effective” as commercial masks and that the blue rectangular surgical masks “don’t have a tight fit” and offer less protection from airborne disease. In recently announcing the mass production of free masks for the general public, the U.S. government has selected the more effective N95 masks, which provide protection against 95% of incoming particles including bacteria and viruses. These masks were formerly only approved for health care professionals due to supply limits. K95 are similar to N95 but are produced in China and may not conform to U.S. manufacturing standards. Typically, K95 masks have ear loops whereas N95 masks have double loops that go over your head which may be a less comfortable but more secure type of fit. Overall “95” masks are quickly becoming regarded as the new-and safest-normal.
Omicron and long COVID-19
-- Dr. Cancio remarked that over 50% of hospitalized patients still have symptoms after 30 days, including brain fog and persistent headaches. Even young people experience these symptoms often adversely impacting their work or school performance, she emphasized. Dr. Sinnott added that while the Omicron variant is often considered “just like the flu,” among his 188 patients now at Tampa General Hospital “none think of it as mild.” The current virus “has caused enormous human suffering and the long-term effects are unclear,” he noted.
On whether to receive the booster shot
-- The panel unanimously supported boosters. The CDC last week published U.S. data showing that if you are 50 years of age or older and unvaccinated, you had a 45 times greater chance of hospitalization than if vaccinated and boostered. Dr. Sinnott further pointed out that so-called “herd immunity” is not a uniform process, is still poorly understood with COVID-19, and affords much less antibody protection than does the vaccination. Last week the CDC also reported that both the Pfizer and Moderna boosters appear highly effective in lowering hospitalizations and death rates from the Omicron variant of COVID-19. Among nursing home residents in Florida, however, only 23% are boostered, ranking Florida in the bottom 5 states in this category, according to the Centers for Medicare and Medicaid Services.
When can we travel?
-- Dr. Lockwood indicated that travel should open up soon especially since the U.S. already has a high concentration of the virus. He noted that “airline travel is relatively safe and we’re not seeing big outbreaks from it.” He added, “the planet is saturated with the virus, so it doesn’t make much of a difference where you are. It’s just (that travel is) a hassle.”
Why can’t we eradicate the virus?
-- Dr. Joel Silverfield pointed out that unlike smallpox, the COVID virus can affect many kinds of animals, not just humans. He also noted that current vaccinations are not as potent against this virus as other vaccines are for other infections like smallpox and measles. It is well known that relatively rapid mutations are a characteristic of RNA viruses like COVID-19 making it a moving target, unlike the DNA smallpox virus which mutates at a much lower rate.
But members of the panel pointed out that our community is not prepared to ramp up vaccinations to a level (85% of the population or higher) that would assure maximal virus suppression. Dr. Lockwood suggested that vaccine hesitancy is a complex issue, driven by both politics and social media, which can magnify misinformation and conspiracy theories. About 15% of Americans and about 20% of Hillsborough County residents remain very opposed to vaccination. Dr. Lockwood also pointed out that the public has been understandably confused by mixed messages from the CDC and by some media reports that may distort the big picture by emphasizing large percentage changes instead of actual numbers which may by quite small.
Dr. Lockwood offered a reassuring long-term perspective in a column published in the Tampa Bay Times, stating “we can take comfort in our evolutionary biology. The most ‘successful’ viruses are easily transmissible, generate mild symptoms, and do not kill their hosts.” In that regard, panelists noted the COVID-19 virus will likely change and so will recommendations for dealing with it.
So where do we go from here?
-- While vaccinations currently cannot eliminate the virus, Dr. Sinnott emphasized vaccinations supplemented with appropriate use of masks and social distancing remains our best hope for reducing numbers of infections, hospitalizations, and deaths.
“It’s going to come down to individual decisions about risk tolerance, which will importantly depend upon factoring in your own individual medical risk factors,’’ Sinnott said. “It will depend upon the nature of the variant that is circulating and its prevalence where you are living or traveling.”
Perhaps in the future, he surmised “we’ll leave for a trip abroad with two test kits and some oral COVID-19 medications much like many us bring along a Z-Pack today.”