As everyone knows, we are having a large increase in the number of COVID cases in San Diego due to the BA.5 strain of Omicron, so if you have any symptoms at all, even if you think it’s just allergies, please test for COVID and let us know if you are positive. And remember, masks are STILL REQUIRED in our offices. We’ve had several people that have been here for their appointments, only to start feeling sick and testing positive for COVID the following day. Masks are still important in preventing us all from getting infected.
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If you have not had your COVID-19 Booster, please read this!
As I discussed last month, I do think it is important for everyone to get a booster shot for COVID-19, even if you are young and have no medical conditions. I discussed the data on the last blog entry, but some people still feel that they don’t need a third shot. Please remember that there are several vaccines that we give that do come in a series of three. HPV vaccines (to prevent cervical cancer) and hepatitis B vaccines are both given as a series of three shots in six months. When they were first released, they were designated as a 3-shot series because the vaccine companies had many years to test and trial various dosing regimens to discover the optimal dosing regimen. When they realized that 3 shots were best, they released them as 3-shot series. Because the COVID-19 vaccines were developed and released without the benefit of years of testing, they were initially thought to be a 2-shot regimen, but after many months of study (and in the face of mutated variant strains of COVID-19), the vaccine really should be thought of as a 3-shot regimen. Therefore, if you only had two shots, don’t look at the third shot as a “booster.” Having had two shots, you should consider yourself as not having the full series for the vaccine, and you should come in to get that last shot to complete the full series. What about a fourth shot? Many people are still asking about a fourth shot, especially if they received their third approximately six months ago. At this point, there are some people that should definitely receive a fourth shot, so if you are one of these people and have not received a fourth shot, please contact the office:
For everyone else, you really don’t need a fourth shot. Studies in healthcare workers in Israel show that a fourth shot do increase COVID antibodies, but they don’t really prevent infection with Omicron. And unfortunately, the Omicron-specific boosters currently being developed by Pfizer at this point don’t appear to work any better than the original booster shot. There is some discussion that a fourth shot may be recommended in the fall since respiratory viruses increase in the fall and winter, just like cold and flu viruses, and we may see a resurgence of COVID-19 then. And of course, if another variant starts to emerge, all of these plans may change as well. What if you still want a fourth shot? Since both Pfizer and Moderna have received full FDA approval, it is possible to receive a fourth shot as an “off label” use. Some people may want to get a fourth shot before they travel, especially if someone at home has a compromised immune system. You should understand that the third shot alone gives you excellent protection against severe illness or hospitalization, and a fourth shot really doesn’t do much to lower that chance any further. It is also important to know that although everyone in our own office received our third shots as soon as they were authorized, no one in our office is currently planning on getting a fourth shot at this time. Despite all of this information, if you still would like to receive a fourth shot, contact our office, and we can put you on a list to call. We still have vaccines that may expire before being given, so if a vial is open and will otherwise go to waste, we can call you to receive the vaccine. At home COVID-19 test kits The two at-home rapid antigen tests that I discussed last time are now available for purchase. Both of these tests seem to be better at detecting Omicron compared to some of the other available tests. Clinitest by Siemens is available at Amazon through this link. In addition, the Roche COVID-19 At Home Test is available through the Optum Store. If you need to buy more at home tests, these are the ones I would recommend. I hope this downward trend in COVID-19 infections continues, and that the worst is really behind us. I will keep you all up to date if anything new develops. 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). Masks 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! COVID-19 Boosters
As many of you know, the omicron variant of the COVID-19 virus is quickly beginning to spread throughout the US. While it does not appear to be more deadly than the Delta variant, it is much more contagious, and even people who have been fully vaccinated and boosted have been getting breakthrough infections. Fortunately the breakthrough infections are generally mild, and individuals recover well, but it is certainly possible if you have coexisting medical conditions that the infection may be more serious. Contrary to my recommendations from last month, with this new data about Omicron, I am recommending that ALL PATIENTS now get a COVID-19 booster vaccine. We carry both Pfizer and Moderna vaccines at the office but are giving them only certain days of the week, so if you want to receive a booster, give us a call. What if you test positive for COVID-19? Neither previous infections nor the COVID-19 vaccines provide you with 100% protection against getting COVID-19. Therefore, even if you’re vaccinated, if you have any symptoms (fever, cold symptoms, unexplained muscle pain, etc.) that could be due to COVID, I encourage you to get tested as soon as possible. You can do an at-home test or call the Scripps COVID nurse hotline at 858-261-8431 to schedule a drive-through test. Important things to remember if you do test positive:
Medicare genetic testing fraud alert Recently, we’ve had several patients contact us about genetic testing. Apparently, there has been a known issue where patients are being targeted through telemarketing calls, booths at public events, health fairs, or door-to-door visits. The Office of the Inspector General had issued a report a couple of years ago, but it is only come to our attention recently. Essentially, fraudsters are telling individuals that these tests were ordered by us, or that they are completely covered by Medicare. Sometimes they have some of your medical information and make it appear that we were the ones that wanted you to have the test. If you receive this information, please do not agree to be tested. If you have questions about genetic testing, please contact our office for an appointment to discuss. Lipid panel delays Apparently, there is a shortage of reagents used to run lipid panels, so many of the tests are having to be sent out. Be aware that you may not receive the results of your lipid panel in the usual time frame, and that the results may look different than before because they may be run by a different lab. There is a lot of discussion now about whether all adults should get a booster for COVID, even if they are at a low risk for complications. If you have risk factors such as increased age or certain medical conditions that put you at a higher risk for complications from COVID-19, or you are in a job that puts you at higher risk of contacting people with COVID-19, you should definitely get the booster. However, there are many young and healthy people who are wondering if they should get the booster shot. While I can’t answer that question for everyone individually, here are some my thoughts about this:
The bottom line is that if you are 18 years or older and want to get a booster, you should be able to get one. We will have both Pfizer and Moderna vaccines in the office, so call for an appointment. The Omicron variant Just a quick word about the recent news this weekend regarding the discovery of the Omicron variant, initially seen in South Africa but now being found in many other countries around the world. Although many people are worried about this variant because it has so many mutations on the spike protein, we don’t know yet at this point if it is much more transmissible or possibly more deadly than the current Delta variant. More information will continue to be coming out within the next week or two. Remember that even if we do see more people that are hospitalized with a new variant, it does not mean that it is more deadly – it could just be more transmissible. If the old virus causes 10% of people to be hospitalized and it infects 1000 people, we will see 100 people in the hospital. However, if the new variant also causes 10% of people to be hospitalized but it is much more transmissible, it could infect 10,000 people, and we would therefore see 1000 people in the hospital. People should not panic at this point, but I would continue to wear masks indoors if you are going to be in close proximity with many other people. While that is true that the face masks we wear do not provide 100% protection against transmitting or becoming infected with coronavirus, it is certainly better than not wearing a mask. Furthermore, wearing a mask is respectful to the people around you, as they may be at higher risk for complications from the infection, and wearing a mask decreases the risk of you transmitting anything to them. Stay tuned, as more information about the Omnicron variant should be discovered in the next few weeks. |