As you are all aware, COVID-19 infections are running rampant throughout our community. Unfortunately, our office staff is not excluded from this. As careful as we have been, we have had staff test positive over the last few weeks. If any of our patients are potentially exposed, we will notify you to let you know what you should do. But because of this, just like many of the hospitals and medical facilities around the nation, we have been and currently are short-staffed. In addition, we are also fielding an exorbitant number of phone calls related to COVID symptoms, testing, infections, and other related questions. Please be patient with the staff over the next few weeks while we do our best to manage this surge in cases, and if we do not get back with you as soon as we usually do, know that we are working as quickly as we can. We are trying to address patient issues first, and we will try to get to the administrative issues as soon as we can.
If you have not had your COVID-19 Booster, please read this!
Last month, I encouraged all patients to get a COVID-19 booster vaccine, even if you are young and healthy. Currently in San Diego, only about 30% of eligible patients have been boosted. We now have data to show just how important a booster is, and it also sheds light on why there have been so many breakthrough infections. A large study done in the UK in December evaluated almost 400,000 adults with symptomatic COVID-19 infections, and they determined whether patients were infected with Delta or Omicron strains. Individuals who received two doses of Pfizer still had a 60% protection against Delta six months after their second shot, and individuals who received two doses of Moderna still had >70% protection against Delta at six months. Getting a booster increased protection against Delta to about 90% up to about 2½ months after the booster dose (which was as long as the study was for). The problem was with the Omicron variant – in patients who did not get a booster, protection against Omicron dropped to about 10% at six months after the second vaccine shot! This shows that over time, the vaccines were not very effective against this new highly-mutated strain. Getting a Pfizer booster after initially getting Pfizer bumped up protection against Omicron to greater than 60% again, and by 2½ months after the booster, protection dropped down to about 50%. People who got the Moderna booster after getting Pfizer got perhaps a little higher level of protection. They did not have enough data for boosters in patients who initially received the Moderna vaccines. All of this goes to show that the booster shots are necessary in everyone to help prevent the transmission of the virus, so please get your booster shot.
What about a 4th shot?
At this point, most people do not need a fourth shot of the vaccine. The preliminary studies in Israel show that although antibody levels increase after the fourth shot, it does not appear to be enough to prevent Omicron infections. Pfizer is working on an Omicron specific booster which may be ready around March 2022. However, hopefully by that time, Omicron will be in retreat.
What if you test positive for COVID-19?
Last month, I recommended that patients 65 years and over, or those with medical conditions that put them at high risk for complications, should get monoclonal antibody treatment if they test positive for COVID-19. Unfortunately, what we have since discovered is that of all the different monoclonal antibody treatments available, only one is effective against Omicron, and the supplies of that one are very low. Therefore, the Monoclonal Antibody Regional Centers are often not able to accommodate everyone for treatment. There are also very limited supplies of oral medicines Paxlovid and Molnupiravir at a very small number of pharmacies around San Diego, so if you test positive and feel that you are at high risk for complications, please contact our office to discuss. What you should remember though, is that if you have been fully vaccinated, your individual risk of dying from COVID is very small, so even if you don’t end up getting treatment, you will most likely do fine. According to a validated risk calculator (www.qcovid.org), a vaccinated 75-year-old woman with active lung cancer has LESS THAN 1% CHANCE of dying. Of course, if millions of people get COVID, there will be many people that die, but your individual risk of dying if you’ve been vaccinated is still very low.
At home COVID-19 test kits
As many of you know, the government is now providing 4 free at-home test kits for each household. You can register at www.covidtests.gov to get your kits mailed to you in 1-2 weeks. The government has also required that all insurance companies reimburse you for up to 8 at-home tests per month. Many insurance companies probably do not yet have the mechanisms set up to reimburse you for these tests, but make sure you save your receipts so you can request reimbursement in the future. Remember, the at-home tests only detect the viral antigen if enough antigen is present, so if you test too early after exposure, there may not be enough virus to turn the test positive, and you may want to retest after a few days. There has been some discussion that Omicron replicates more in the throat so that a throat swab may be more accurate than a nasal swab. Although this might be true, all of the at-home test kits were developed to be used with a nasal swab, so the FDA does not recommend using them for throat swabs. Finally, the studies show that the current home tests may not be as good at detecting Omicron compared to the previous strains. However, two new tests have received Emergency Use Authorization and seem to be better at detecting Omicron, and hopefully they will become available in the next few weeks. These tests are manufactured by Siemens (called Clinitest) and Roche (currently called SARS-CoV-2 Rapid Antigen Test).
With regards to masks, we have known that N95s are the most protective, followed by KN95, then surgical masks, and finally cloth masks. There are 2 important things to know about how well a mask works: how well does it filter and how well does it fit? The reason N95, KN95 and surgical masks work better is because they FILTER particles, including viral particles, when air moves through the material. The tangled fibers in the material of a N95 mask can trap particles and keep them from passing through the mask. Simple cloth masks simply do not filter particles as well. However, the FIT of a mask is just as important. N95 masks almost always have 2 rubber bands that go behind your head so that the mask is plastered against your face, and no air can leak out around the mask. If your N95 is too big or you’re not using both bands, air can leak from the sides, and the mask is no longer as effective. If you wear a KN95 mask, make sure you bend the nose piece to the bridge of your nose so that air doesn’t go in and out of that gap. And although surgical masks are made of material that can effectively trap particles, they don’t fit as well against your face so that air (and particles) can bypass the mask by escaping around the edges. These masks ARE effective, but just not as effective as N95 masks. So if you’re going to “double mask,” it does not make sense to put 2 surgical masks on top of each other, because air will continue to leak out around the sides. If you are going to double mask, use a surgical mask underneath, covered by a cloth mask that is tight enough that it helps plaster the edges of the surgical mask against your face so there is less chance of air leaking around. And of course, this explains why just wearing a face shield without a mask makes no sense in protecting you from COVID-19.
The government is distributing 3 free N95 masks to each individual in the US in the next week or so, although the details about how to get these are still not known. N95 masks may be the most protective, but as anyone who has worn one can tell you, they are not comfortable because they are plastered tightly against your face. I would recommend wearing one whenever you are in an indoor situation where there is a higher likelihood of encountering people with COVID-19, but I do believe in the statement that the best mask is the one you’re willing to wear. If you use a N95 but keep taking it off because it’s uncomfortable, it is not as effective as a surgical mask you are willing to keep on. You can re-use the masks, and when you need to buy more, here is an excellent article from the New York Times that discusses the different types of masks. Because there are also a lot of fake masks on the market, the CDC has published a guide for identifying fake N95 masks.
Once again, this is a lot of information to digest. Stay safe, and we will keep our fingers crossed that in one or two months, things will be looking much better!