This webinar was recorded on Thursday, May 19, 2022
We have a discussion of the incidence, distribution, and possible control of COVID-19. We’ll look at community issues, nationwide transmission and important ongoing prevention strategies.
- Dr. Purvi Parikh
- Tonya Winders
CE is not offered for this webinar.
Transcript: This transcript is automatically generated. While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.
Speaker 2 00:05
COVID-19 has been with us for over 2 years and we are beginning to have research and study data to guide our healthcare decisions. This helps us to see the “big”picture and move forward with data-driven interventions and treatment. Welcome to today’s webinar, COVID-19 an epidemiological view for our communities and schools. I’m Tonya Winders, President and CEO of Allergy & Asthma Network and we’re pleased that you have chosen to once again join us today. We have over a thousand people registered for today’s webinar and over 300 already actively online. This webinar is the 36th in our COVID-19. COVID-19 is a part of our Allergy & Asthma Network, living out our mission to end the needless death and suffering due to asthma, allergies and related conditions. Through our four mission areas, outreach, education, advocacy and research. Today, we welcome Doctor Purvi Parikh to our webinar. Doctor Parikh is an adult and pediatric allergist and immunologist at allergy and asthma Associates of Murray Hill. She is currently on faculty as clinical assistant professor in both departments of medicine and Pediatrics at NYU School of Medicine. She’s been passionate about health policy and is on the board of directors of the Advocacy Council of the American College of Allergy, Asthma and Immunology. She is also the spokesperson for Allergy & Asthma Network and frequently appears as a medical contributor on our behalf to all the major networks, NBC, Fox, CNN, Wall Street Journal and CBS. Again, we thank you all for being with us today and we look forward to hearing from Doctor Parikh in just a few minutes. So here is an outline of how we will spend our time together today. First, as we always do, we’ll take a look at the current state of COVID-19 and then we’ll turn our attention to vaccine and treatment trends and finally conclude with an epidemiological view of COVID-19 in communities and schools as we come up on the close of this particular school year. But first, as we get started like we always do, we would like to know who is with us today. So I’m going to launch the very first poll and ask you to respond which category best describes you. Is it physician, PA, ARNP nurse, school nurse, respiratory therapist, asthma, educator of health, educator, patient or caregiver? So give everyone just a moment to log in. Your response here. And once again looks like we’ve got a multidisciplinary group that has chosen to spend some time with us this May afternoon. So really appreciate that. We’re going to close the poll and share the results. Looks like we have about 78 % are school nurse. Not surprisingly, especially given our topic today, 14 % RT’s, asthma educators, health educators and then about 8 % physician/ PA and patient caregivers total. So again, we’d love to see that this does attract a variety of different multidisciplinary healthcare providers as well as patients. And caregivers. So what is the current state of COVID-19 here as we sit today, May 19th, 2022? Well,, we always go to the Johns Hopkins dashboard and as you can see, our total case rate is now over 525 million with over 6.2, almost 6 3 million deaths. And we do still have over 11 billion total vaccines that have been administered. And so again, we’re in a good place when it comes to vaccination and yet we are still seeing some trends in upkicks of COVID-19 especially in certain regions of the country. And so we’ll look at that in just a little bit more detail here in just a moment. So the CDC, the current cases of COVID-19 remember the darker the blue, the more cases that are being presented, the higher the case rate per 100,000 thousand is by state or set territory in the last week. And I actually just returned from a trip from California where their case rate had increased from about 1 to 2 % of the population to over 5 %. So I think we’re seeing some of these hotbeds and definitely across. Different areas and they are in those darker shades of blue here on your screen. Now what about the headlines? How are the headlines shaping up as we again are beyond the two year mark of the pandemic and living in this time. So unfortunately the US death toll for COVID has now topped 1,000,000 people and making it again even more deadly than the Spanish flu of 1918. And an average of more than 90,000 new cases are being identified each day in the US, and as I mentioned, this is a pretty significant increase from just two weeks ago, so 60 % increase over the last two weeks. We are seeing this pocketing in the Northeast and the Midwest and as the virus evolves, people really can have even a third or fourth acute infection and as we know unfortunately so many are still living with symptoms that persist for months or years even after that acute. Infection period. I’m as we have talked about before with long COVID and effects, but I personally know several people that are on their third or fourth round now of unfortunately having acute COVID. However, things are continuing to resume to somewhat of a faster pace. Business travel resumes. Masks are no longer mandated on airlines since the last time we were together. It’s not in its former pace before the pandemic, but we are definitely seeing more things open up. I was saying earlier for myself, I had not traveled internationally for over 2 years and now all of a sudden, have four planned trips between now and the end of the year. So I think that many more business meetings and travel even for vacation or fun is beginning to be more evident in our society. We also have seen significant upswings in small and large business meetings and although some businesses do continue to restrict travel and certainly try not to have large what would be called. Spreader events. We are seeing also that some school mass mandates are returning given the increase in case rates of children specifically now in the southern United States, we are nearing the end of the school year. I think in the North and northeast we still have a few weeks left, but I know that many teachers are elated that summer is coming. Many school nurses elated that summer is coming, but one of the reasons is definitely to see this trend in the increase of paces stop and fewer children become infected. Now there is some late breaking news. On Tuesday, the FDA authorized a booster dose of the Pfizer-Biontech COVID-19 vaccine for children ages 5 to 11. And children in the age group can get a booster shot at least five months after they’ve received those primary 2 dose series. Americans also can once again order their free COVID-19 tests from the federal government, and you can do that by visiting COVIDtest.gov in this particular round, the USPS, the Postal Service will deliver up to 8 free rapid antigen test to any household in the US that wants them. So feel free to visit that website again, that’s covidtest.gov to get your additional at home test. I was saying I just traveled internationally. We had to be tested in the airport and in Spain, they charged. 50$ 50 euros per test so it’s nice that the American government is providing these at home test kits free of charge. So now let’s go to our second poll. What do you think the CDC reporting shows about COVID cases in the US? A large spike showing a high number of new cases showing slightly upward trends, no change in cases, slight decrease in COVID cases are large dip showing a significant decrease. So go ahead and log in your response. And we’ll see how we’re trending based off of your thoughts, of the way that the CDC reports current COVID cases for the US. What I will tell you is that the behaviors across the country are very different. We just had an event in Washington DC. A couple of weeks ago and from the two weeks in DC and then the two weeks that are the week that I was abroad coming back and going to California, you see different trends in different regions of the country. And yesterday I flew through California, Colorado and then into Tennessee and even the mask wearing and engagement on the plane was quite different from place to place. So here we see that about 63 % say the cases are showing that. Slight upwards trend, 33 % say that larger spike with a high number of new cases and then the other remaining 4 % at the bottom of that poll. So again we can see that there are those upward trends just in the last two weeks and again we are going to talk a little bit more about how we can continue to hopefully reduce these trends as we move forward. So here are cases by day reported from the CDC, you can see those daily trends and again that huge spike that we saw in late December, but this slight uptick that we see here at May seventeenth as we’re coming back towards that 100 to 200 thousand mark of those daily trends. So again, nowhere near what we experienced at the height of the pandemic, but certainly a slightly disturbing upward trend. So now I’m going to turn it over to Doctor Parikh is going to share with us a bit more about vaccine and treatment trends. Doctor Parikh.
Speaker 1 12:35
Thank you. Thanks very much for that. Very nice overview. So that will take it away because there’s been a lot in the news regarding vaccines and treatment. So you know, the most up-to-date CDC COVID-19 vaccination info, you know shows we’ve come quite a long way, but there’s still quite a bit of work as well in terms of boosters as well as vaccinations for children. And remember the under five groups still does not have a vaccine available for them. That being said, you know, over 700 million doses have been distributed, over 500 million have been administered and we have 220.7 million people fully vaccinated, which is, which is huge. But where we’re falling short unfortunately is with the boosters. So about 102 4 million have had their first booster and that’s how many doses have been administered. And about 12 1 million have had their second booster and this is important because as we know we are starting to see some surges, newer more infectious variants and sub variants. And this is a great map, you know, which shows kind of vaccine coverage throughout the US, you know, certain areas do tend to do better than others so that there are darker states, Vermont in particular has a very good vaccination rate. And in terms of vaccines by vaccine type, you know by far the majority of people have had the Pfizer shot followed by Moderna and then J & J and others which makes sense because Pfizer was the first to receive their emergency use approval. They also have the widest and also the 1st to get their official approval and they have the currently the widest indication in terms of age groups as well you know we’re hoping modernas. Pediatric vaccine will be approved soon in June as well as other vaccine platforms. You know, there are, there is a strong case to have things like the Novavax vaccine and other novel platforms approved because as we know, you know some people may not tolerate the Moderna vaccines and there’s many vaccine hesitant individuals who have said that they would take an alternate vaccine platform. So again, you know we still have work to do, but you know it’s quite amazing. How much has been accomplished in just the two years. But the one thing of concern, and you know, there’s this has been all over the news. It was in the New York Times that a big story on this a few weeks ago is that there’s been a decline in routine childhood vaccinations during the pandemic. And as a result, we’ve actually been seeing outbreaks of diseases that were virtually wiped out before. So measles, for example, you know, there weren’t many circulating. Places at all and folio where we’re almost at global eradication, we’re now starting to see increases in these and they would be awful, you know, to see all the hard work of, you know, decades of global agencies kind of be set back by this. And you know, when COVID-19 spread, there were very strict lockdown orders, stay at home orders throughout the country and the world. And as a result, many children didn’t go for their usual pediatric checkup. So that’s where they get their routine vaccinations. And this of course happened to adults as well. But if these children don’t get these crucial vaccines in the early few years of life, it can lead to these outbreaks. And for immunocompromised individuals and children who haven’t had vaccines, they can be quite dangerous and even deadly. These office visits for children age three to five, that critical age dropped from was 75 %. So you know with that you know we’ll move on to the COVID-19 treatment. So treatment options also have increased exponentially for those inpatient and outpatient too which is huge. So for non hospitalized patients there’s many things that we can do. So if there are mild to moderate symptoms, you know a healthcare professional can actually, you know, delineate what they’re high risk status may be. So that could include certain medical problems like obesity. Diabetes, chronic kidney disease, a weakened immune system or if you’re taking a medication that weakens your immune system. And the great thing is now we have antivirals. So before the antivirals, the monoclonal antibodies were kind of the mainstay of keeping people all the hospital, but these were difficult to obtain. You’d have to get an appointment and infusion center. Now it’s very easy with these antivirals. And just from personal experience, you know we’ve been seeing surges, especially in the New York City area in the last few weeks. And I’ve been writing for these antivirals nearly every day, but it’s very convenient because my patients can call in, you can do a telehealth visit and I can get them on appropriate treatment right away, whereas before, you know, you just have to hope for the best. So that is also a big step forward. And then in terms of the NIH treatment update there, you know in terms of therapeutic management for non hospitalized patients, this is very important. You know previously the panel had recommended the monoclonal antibodies, so Tiamat as an option because it still was working against the Omicron BA one and 1 1 sub variants, but it does have decreased in vitro activity against the newer amacrine BA two sub variant that has unfortunately become the dominant variant in the US right now and because the Omicron BA two sub variant is now the dominant circulating sub variant in all regions of the United States, the distribution of so trove amab has been paused, you know, and will no longer recommends using it. The recommendations and rationale for this have been unfortunately removed. So this is the concern that we have with these newer variants that often get downplayed as mild. The problem is they’re not always. Mild for everyone and they render important treatment options not effective anymore, which is the worst thing we would want, right? Next slide, so far it appears that the antivirals are effective, but the issue is that, you know, we’re now already seeing some cases where one round of the antiviral may not be enough and we may have to do a second course and we’re trying to figure out why that’s occurring. So again, it’s still important. You know, as these mandates come down to keep those common sense measures going because we don’t want to lose all of these wonderful treatment options. So with that, we’ll touch on an epidemiological view of COVID-19 in communities and schools because this is where we are seeing the bulk of the cases. So just kind of recapping the history and in case anybody has forgotten or blocked it out, you know, due to how traumatic this whole experience was. And then, but, you know, it began in China near the end of 2019 That’s how it got its name, you know, the cluster of cases in the province of Wuhan. And then it spread rapidly, you know, not only throughout China but the world. You know, by March we were already in pandemic status. So, you know, in February 2020 I think we had declared, you know, this was something of concern, but by March it was already at pandemic level. And in terms of the virology, just so we understand coronaviruses, you know, these aren’t new viruses. Even the common cold is a type of coronavirus. If you remember SARS, you know for and MERS, these are all coronaviruses. So what they are, they’re enveloped positive stranded RNA viruses. And like other viruses, these mutations evolve over time and that’s kind of how the SARS-COVID2 or COVID-19 virus developed. And we can see currently, the mutation or variance of concern are omicron, you know, because right now they are the most dominant strains. And Omicron first broke around Thanksgiving time, if you remember November 2021 And it kind of ravaged the whole world, especially in the US in December 2021 over the holiday season. And the reason why we were all worried about this variant was because it had so many mutations that spike protein and that’s what all of our vaccines and treatments are again. So, when that occurs, there is, you know, a worry that this will be more contagious. Could this be more severe or deadly and is this going to evade our, you know, treatments and vaccines and other therapeutics and then that same variant then further mutated into sub variants and as you can see with the BA two and now subsequent ones, we are seeing that they are very transmissible, even more so than the initial. Mind blowing to me because even that seemed so contagious at its peak, but I believe it because it is starting to feel a lot like how it felt in December. I’m hearing almost on a daily basis about people, either patients I know personally or just people in general getting sick. And we’re also starting now to see the hospitalization rates rise again, which is also of concern. And then if you remember there were other variants of concern too that emerged and became dominant. So for example alpha, beta, the gamma and the delta variant. So again you know the risk of severe disease may be lower, but that is more for vaccinated individuals and you can go ahead and reduce that risk by getting vaccinated. But you know, certain high risk individuals of course should always be careful. So kind of just getting everyone on the same page, you know, what exactly is epidemiology. So this is kind of what the methods that are used to find causes of health outcomes and diseases in populations. So this is exactly what, you know, large centers like CDC or Johns Hopkins or the World Health Organization uses, you know, so they study very scientifically, systematically using data and evidence on what is driving infections. And this occurs with nearly every infection there is, and even non infectious public health threats. So there’s epidemiology of obesity, asthma, a whole host of other medical problems. And the important thing about epidemiology as well is that it also takes into account, you know, where the geographic distribution is. So it looks at global cases, you know, globally how many are reported. It also looks to see if things are underreported and then, Sarah, prevalence, what that means is they look at the rate of, you know, prior exposure as reflected as seropositivity. This means if you’re showing that you have immunity. To a virus. So either antibodies or T cells and other stuff because this gives us an idea of even if these people didn’t know they had it, we still get an idea of how widespread the virus actually was. So for example, if you look at global cases, there’s, you know, 400 million reported cases. But the actual 0 prevalence meaning people showing they’ve been exposed is actually tenfold that. So there must be many cases that are going underreported, mostly because people may not even realize that they have it. And of course, roots of transmission. Everybody should know this cold by now, but direct person to person transmission is the primary means through both respiratory and aerosolized droplets. It can occur through contact on surfaces. Luckily the surface transmission is not as much as the, you know, person to person. And of course it’s through respiratory suppression, so, coughing, sneezing, wheezing, singing, talking loudly, all these things can spread it and soak in your hands. So we always keep saying, you know, keep washing your hands. And again, the airborne route is never a good sign because that just means that the virus can travel further. spreads between two people. So the viral shedding and period of infectiousness is it’s potential to transmit COVID-19. So this takes into account you know even prior to anyone having symptoms how long that virus has already been in your body replicating and potentially being passed on to others. So transmission and how long it continues to be passed on to others, right. So this gives us idea about quarantine and isolation and things like that. So transmission after 7 to 10 days of illness is unlikely, thankfully so. That’s why many of the guidelines are around this, and why it’s so important to know, you know, how long the shedding is, how long that period of infectiousness is. And again you know the infectiousness, there’s so much that takes that into account. So you know somebody is much more infectious earlier on and their illness versus later on. That’s why you know even rapid tests are very helpful at day five or six of your illness to see if you are potentially still contagious because it gives you an idea of how much viral load or viral replication you have and then your risk. Other individuals too at that point and then in general you know the prolonged viral RNA detection does not indicate a prolonged infectiousness but then this does not take into account you know what’s going on and long COVID and all of the chronic complications that come after this we’re only talking about the immediate or acute infection. So remember there’s always pre symptomatic and asymptomatic transmission this site defined as the most dangerous because people who don’t know are passing it along, especially right now during allergy season. And everybody is, you know, coughing and sneezing and I’ve seen a few people mistake their allergy symptoms for COVID and vice versa. So you have to be careful environmental contamination and touching surfaces and things like that. And then the risk of animal contact, although we don’t know really what that risk is because it’s hard, you know, most animals won’t report. If they’re not feeling well or get tested so that one is also still uncertain, but there have been cases at zoos and dogs and pets, whatnot. And then risk of reinfection, so this has also evolved. I think Tonya mentioned earlier, she knows individuals and so do I that have gone through two or three rounds of this virus. And initially we thought that the reinfection was pretty rare, but now that we’re seeing with these newer variants, and people are getting reinfected and it’s not so rare. So earlier, you know, we found that at least within the first several months we weren’t seeing. Too many reinfections especially if you were infected before and your chances even improved when if you were vaccinated and infected because then you had kind of that dual or hybrid immunity. But you know the severity of infection may play a role that at least the reinfections are milder than the initial ones. So that’s a good sign that you know we are as a population building some immunity and you know the viral test after recovery does not necessary. Indicate reinfection because remember, especially the PCR test can stay positive for a very long time, even up to three months. So even though the PCR test is more accurate in many ways than the rapid test, the rapid one may be a little more helpful in identifying what’s a new infection versus not, especially if they’re very close to one another. So I’m going prevention strategies, obviously infection control, we want to prevent this from occurring in the healthcare setting, prevent personal preventative measures. You know, everybody is responsible. You know, we got to keep washing our hands, masking when appropriate, you know, getting the vaccinations and boost.
Speaker 1 29:53
Speaker 2 29:54
Know, being careful, especially the social physical. Christian saying not forever, but if it is a time where there is an increased surge or transmission time, then you know we may want to scale back on some very packed activities and of course screening and very high risk settings. So large long term care facilities, college campuses, many conferences now are screening you know air travel as Tonya mentioned. So these are all things that help mitigate the risk and of course other public health measures. In schools, travel and contact tracing. So then post exposure management, so the main thing is of course being tested and getting quarantined. Our strategy is to quickly identify secondary infections and someone expose and reduce the risk of that individual exposing others. And use of monoclonal antibody combinations can also help with certain high risk individuals as well as you know use of the antiviral if you are symptomatic and high risk. As well. And then in terms of schools, now this is schools have always been a big concern for all infections. You know, people often joke that, you know, daycares and schools are like Petri dishes because kids are always getting sick at baseline. And now it’s a bigger concern, especially with COVID-19 because so many children are either, one, not fully vaccinated as of yet, or don’t even have access to a vaccine yet due to their age. This has been a tremendous toll for America’s students of course and educators and everybody involved in the education process. And you know we need good proven virus strategies to be in place so we don’t leave any child behind until everyone can get the equal protection and these reports come down. So you know the goal of the road map which we’re going to go through on the next slide is to make sure every student, you know, has the support and opportunities they need to heal. Learn and then grow in their classrooms, right? And create an environment where they belong and can thrive. Because we’ve seen what happens when kids are taken out of school. It’s a huge detriment to their health, not only physically, but mentally, developmentally. So we want to keep kids in school, but safely, you know, so the return to school road map, vaccinations key, you know, some are learning safely reopen schools. Mental health support is huge. American Academy of Pediatrics declared a mental heart health emergency. And emergency rooms also are reporting that they’re seeing more adolescent and teenage suicide watches than ever before, and that’s very concerning. And then address lost instructional time. You know, we don’t want children to fall behind significantly as a result. So again, all of these features are very important to keep our kids. Healthy and in school. I’m happy as well. So it’s key that there is, you know, support for children and students with social, emotional and behavioral mental health needs to prioritize wellness for each and every child student, educator and provider. Remember, there are, there is not, it’s not only the students, but there’s a lot of risk to everybody involved in education as well as the people taking care of them there. And all of the burnout and stress that comes along with that as well enhance mental health. Literacy, reduce stigma and other barriers to access, implement a continuum of evidence based prevention practices and establish an integrated framework of educational, social, emotional and behavioral health support for all. So and then and this is, of course, everything takes policy, takes funding, to enhance a workforce capacity. So it’s not easy, but I think there has to be a systemic change that will support this and we need to use data for decision making and to promote equitable implementation and outcome. So, you know, schools should not be a political tool. We should be using data to drive a lot of these decisions and policies. So, you know, today’s concepts, they all kind of contribute to the big picture of COVID-19 and that’s why we want to have this webinar, you know, because the virus unfortunately still here, but important to look at the full big picture, not lose the forest for the trees. The virology is of course very important in understanding this virus, how it spreads, its epidemiology, root of transmission infectiousness, we have to and then also the school concerns. Because so many of our current cases are coming out from schools, from students, the return to school culture, student well-being And remember, we’re all in this together, you know, so this isn’t isolated, only the schools and communities. Everything is interconnected. And you know, we have to work together and band together to continue to get through this. With that, we’ll go on to a very interesting poll question. Will you continue to wear a mask on airlines or public transportation? Yes no, I’m not sure. Or I didn’t wear a mask previously. The fourth answer is kind of funny. You probably didn’t get very far. Probably didn’t walk outside the walls of your home, right? Yeah well, again, as I was saying before, it’s been interesting getting back to some degree of travel across the US and abroad and seeing the behaviors and my flight over to Europe. We were forced to wear a mask the entire time. The flight back from Europe we were not. And so it was. And it was all depending on the airline and the country in which they were based in their policy. So it was that was kind of fascinating to me as well and. Definitely state we’re still seeing a lot of different behaviors, but it looks like we’ve got just about 70 % voting. So I’ll go ahead and close the poll and share. So 79 % say yes, they’ll continue to wear a mask, 8 % no, 13 % not sure. And thankfully we didn’t have anyone that had avoided wearing a mask altogether. I’m not sure how they would have, again, is this to be on their home, but you know, I think that this is a very personal decision. And the today’s topic, Dr Parikh, in the way that you’ve explained it helps us to make these decisions for ourselves and for our loved ones in a much more informed way. And so I definitely appreciate you giving us those insights today and that overview of virology and epidemiology. So now we’re going to turn to your questions, to the audience’s questions and once again just want to thank you all for tuning in today. Let’s go to our question panel to see what we got thus far coming through, right. So Dr Parikh,, this question comes from Emily and she says how are we now, how can we now measure the start of a new acute phase given the decreased time between reinfection, sometimes rapid tests are still positive from the old infection even, you know, weeks after. So how do you know that new acute phase versus just reinfection?
Speaker 1 38:03
Right So generally, I mean the PCR tests, they’re the ones that do more so than the rapid tests tend to stay positive for longer periods of time in most individuals. The rapid tests actually you know can stay positive even up to seven, ten or 14 days even. But we haven’t seen too many cases where rapid tests stay positive as long as the PCR like PCR can stay positive for almost 12 weeks. So that’s why rapid sometimes is more helpful for the acute phase, you know, the other helpful thing is if you notice, like a resolution of your symptoms and then a return of symptoms and that rapid never turned negative in between, that could also be a sign, you know that it’s a reinfection. But that’s a good question because in some cases it’s very difficult to tell. You know, is this just an ongoing infection or is it a reinfection or sometimes it is very hard to tell, but those are some ways to differentiate it if it helps.
Speaker 2 39:04
Ok. And this next question is one that we hear quite often. Why do we continue to encourage or focus on vaccines when we know it doesn’t prevent infection? So they had their school population 94 % vaccinated, yet they’re seeing that recent surge, right? And she’s questioning why we still focus and encourage vaccine.
Speaker 1 39:30
Yeah, that’s I think a great question too and I think there’s a lot of misconceptions on vaccines and how they help with immunity in general. But one, you know the vaccine, it is not 100 % guarantee against zero infection. So even with the flu vaccine or any other vaccine, there’s still some chance of transmission of infection. But that being said with a vaccine does is it prevents to great extent that severe disease hospitalizations. So in the event that you do get sick, one, it’s a much milder course and you don’t end up, you know, dead or in the hospital or many other, you know, awful long term complications. And actually there are studies that are showing that it does even prevent infection rate. So in certain areas where vaccine rates are higher, there is less transmissibility and even if the transmissibility occurs, it doesn’t progress. So, I maybe, picked something up but because I’m vaccinated and boosted. For me, I stay asymptomatic. Whereas if I hadn’t been, I might develop breathing problems or other issues and end up in the hospital. And there’s actually also been a study that it does improve. You know, the reason why that transmission can improve is because your actual viral load is much lower if you’re vaccinated. So it still helps out in the whole community, you know? And ironically, a lot of these variants have emerged because of, you know, being LAX. The restrictions and vaccinations. So it’s almost like they’re a victim of their own success. So a lot of vaccinated individuals are catching new variants. But you know, with these variants have occurred if our vaccination rates were higher. You know I can’t say with any certainty but ironically I think some of the new more evasive variants may be coming out of areas where there were less vaccinations. So I hope that made sense for a little bit of a chicken or egg thing. But it’s still in everyone’s best interest to make sure everybody is vaccinated at least. Even just from the bottom line, right, is that we know vaccination will not necessarily keep you from being infected. However it does significantly increase the likelihood that you won’t be hospitalized or die from. So I think that that’s still the most important or compelling reason why people have, you know, are continuing to take those strides and be ever so cautious now. Janessa asked a question about antiviral medications. Have you seen anything about using antiviral medications for people who have a positive, I’m sorry, who do not have a positive COVID test but actually have the same symptoms?
Speaker 1 42:20
Yeah, that’s actually a great question. So, even if, without a positive test in many states like New York for example, you can be prescribed the antiviral with onset of symptoms, especially if it’s a high risk individual living in close quarters with someone who’s definitely positive. I as a physician would 100 % still prescribe it because there’s a high likelihood, you know that’s what it is all being all things being equal, so most times. When you prescribe it, the positive test is not even required. You know it’s just the symptoms and other factors.
Speaker 2 42:59
Ok, great question. Great question, Vanessa. So the next one comes from Donna and says how long do you believe that the virus lives on glass or on surfaces with new guidelines since 2019 Has anything changed in kind of the length of time that we think the virus can live on those hard surfaces?
Speaker 1 43:20
Yeah, actually the good news is I think that length of time has significantly shortened. If you remember earlier on in the pandemic, there was concern that these, the viral particles could live on surfaces for 48, anywhere from 48 hours, I think even five days. And everyone, myself included, was wiping down everything, mail, any package that came, leaving it outside the house, whatever you everyone was doing for a significant period of time. But now we know that luckily. It’s likely much less than that, probably hours, definitely not days and you not even a full day I would say. But I would say anywhere between 12 hours or studies show even less than that. But still again you can spread it through hand contact or other close contact if you’re sick because you’re constantly shedding viral particles and you’re constantly you know, wiping your nose unknowingly or sneezing on yourself and that’s why it’s still very important to continue that hand washing. Especially if someone touched a doorknob who’s just, you know, sneezed into their hand, then that could have been seconds prior. So that’s why it’s so important to wipe down surfaces. But luckily it’s not this day’s long thing like we initially thought. Thankfully that’s a great clarification and definitely the thought has changed over time. So Cheryl asked us from a school nurse perspective, since we now have treatment and vaccinations at what point do you think we can stop quarantining in the school setting, you know that in her school they actually have people who have no symptoms but have had to remain home for upwards of five days and wondering if that’s still the, you know, a warranted measure.
Speaker 1 45:06
Yeah, you know that that’s a great question. I think like everything in this pandemic, our understanding will continue to evolve. The problem is we do know that there is asymptomatic spread, but it’s hard. We’re still, remember, only two years into learning about this virus, I think we still need to learn more, which individuals are more likely to infect others. So for example, even going back to the other question about vaccines and transmissibility, the guidelines already say for. Many individuals, if you’re vaccinated and asymptomatic, even if you’ve been exposed, for example, for health care workers, that quarantine is no longer necessary, whereas before it may have been in for, you know and of course we don’t want to wipe out our healthcare force. I think that will continue to evolve. The reason why schools are so much stricter is that vaccination rates are not very high in schools as compared with the general population. And remember, there’s a whole large group of children that don’t even have a vaccine available yet. That was five and under, so that’s why I think it is still the right move to be a little bit stricter in schools with children because of the lower vaccination rates.
Speaker 2 46:16
And a very appropriate follow up for Margaret. Do you think that the COVID vaccine will be a mandatory school vaccine?
Speaker 1 46:24
I mean it very well may be. There’s already 11 mandatory school vaccines, so this isn’t anything new. I know it’s a very controversial issue, but it’s not the first one, let’s put it that way, you know, so in a very well maybe we don’t know. I mean hopefully we reach a, get to, a point where enough of the population is immune and there’s not these variants coming as frequently in that it doesn’t have to be a mandatory one, but it is a possibility. Now, this isn’t the first time.
Speaker 2 46:57
And Rosa asked a question in regard to what percentage of the population has not received vaccine. It’s about one in three right, that has not been vaccinated at this point here in the US yes and I think that for the booster it may be less so I yeah.
Speaker 2 47:18
But that’s the original series. Yeah, that was my understanding as well. So Peter says, what are the risks to the child, children or want together when the risks seem to be different depending on age? What does the data show as far as risk based off of age? Perhaps preschool or infant preschool, you know, elementary versus middle school, high school?
Speaker 1 47:44
Right. That’s also a great question. So the good news, by the way, is that it seems that overall children have not been having as severe complications from the virus compared to the adult counterparts, but older children do. So you know if somebody is a teenager or you know sixteen seventeen eighteen we’ve seen just as bad complications as we do see in adults and then even in the younger children we’ve seen at multi systems. Inflammatory conditions vary that can be very dangerous and put children in the intensive care unit even as you know young as five or six years old. But overall luckily it’s not as frequent or as common as we see in adults. So that’s a very good sign I think. But that being said, remember we still have a whole population, I sound like a broken record of children like infants and under five that have no access. And the other thing too is we don’t know what the long term effects are and will newer variants be more dangerous in children? That’s possible too. I mean, remember we’re even seeing pediatric long COVID cases now, which we weren’t as much a year ago. So, you know, I wouldn’t assume anything at this point.
Speaker 2 49:02
Emily asked a really great question about this because there’s been a lot of discussion around the workforce, right. And the fact that many school health offices have returned to sort of pre pandemic staffing and she’s expressing, you know, do you think that that’s appropriate. Do we really think that schools need to have that increase in staffing because it seems like it’s overwhelming or impossible? As a caregiver to think about a single school nurse, for example, overseeing and we know in some states five school buildings.
Speaker 1 49:40
All right time.
Speaker 1 49:43
Yeah, absolutely. I mean I think school, I think it’s a concern 100 % because school nurses were already so understaffed pre-pandemic and now you throw in this variable where you know cases are constantly going up, especially in the pediatric population as rules change and you know, mandates go in and go out. So yeah, I think that it’s a huge problem because it is very difficult for one nurse to oversee even one school with, you know, having multiple COVID cases and whatnot. Let alone multiple schools, so i think. That’s why we have been advocating right on Capitol Hill for the Nurse Act, because we need at least one school nurse in every school for sure. And so the next question comes from Lori, who says they’ve been discouraging the use of nebulizers since the onset of COVID in their school. Is this something that they should continue to discourage?
Speaker 1 50:38
Yeah so this is I think a very regional issue. So if your school is in and it can change from time to time. So if you’re in an area that’s not a high transmission rate, the nebulizers can be used very sparingly, remember. So nebulizers again should only be used in emergencies. So if a child’s asthma is uncontrolled, then, one the child needs better asthma control. They shouldn’t be nebulizing all the time or every day, but if needed, it shouldn’t be done in those. Low transmission rates because that does increase the risk of virus spreading. So if the school district is in a time where things are surging then you may want to stop the novelizations at that time. So for example, New York City went from one of the lowest transmission rates and now we’re at high level again as of yesterday or the day before. So again these guidelines, these guidances change as situations change, but just in general nebulization shouldn’t be occurring in large volumes, you know then the underlying issue has to be addressed.
Speaker 2 51:39
Yes, absolutely. Now Lucy has a good question. Is the stealth virus evading the vaccines, and is it attacking the lungs in the same way that delta seemed to?
Speaker 1 51:55
So I mean it’s the answer is yes and no. Yes, it’s in the sense that the cell virus is much more contagious, so it’s much easier to catch the stealth virus and it was delta. But it, no, it’s not evading the vaccines because for the most part these infections are mild, especially in vaccinated individuals. That means that these people are still very protected against severe disease, hospitalizations, death, which is very good news, right, because nobody wants that so. And it is more contagious, but it’s that flip side of that. People still aren’t getting extremely ill. So that’s very good news. I think that’s a good sign that vaccines are not evaded.
Speaker 2 52:37
And Eric poses the next question about is there any assistance or reimbursement programs for someone who was hospitalized for an extended period of time due to COVID? We do have a couple of programs where there are funds available for support if you are recovering from COVID or experiencing long COVID, so please do Eric, send us an email allergyasthmanetwork.org and. We will connect you with those sources for that support. All right, we have just a couple more minutes. So a question about how? What is the length of quarantine that you would recommend for a student who is negative and on the test but yet has symptoms?
Speaker 1 53:31
So yeah, for anyone who has symptoms, I would say they should stay home until they’re no longer symptomatic because symptoms mean you’re spreading something. It doesn’t have to be COVID-19 but we don’t want flu going around either because it can be very dangerous in kids, more so than COVID-19 or any other. We’re seeing a lot of viruses, as you may have heard on the news, there’s a rise in these mysterious hepatitis cases in children. And many of those we think are linked to adenovirus, which is a very common virus passed around, so. Any symptoms please stay home is the bottom line. Yeah, that was a question. Another question, the chat was from Gene about the recent acute liver failure in children linked to COVID or other virus.
Speaker 1 54:16
It’s possible. I mean we, they’re still investigating, but over half of the kids I believe did have adenovirus infections prior. But I wouldn’t completely rule COVID out you know, because as we know the testing isn’t great for COVID. Many cases are underreported or under tested. So it could still be a link to it, but just the fact that it’s there, I think, is a reason to stay home if you’re not feeling well.
Speaker 2 54:43
And then I think this is a great question to end on because I think this is the question that we all still have. Do you think they’ll ever be a time where we’ll treat COVID like the flu, where, you know, we’ll treat with antivirals, return to school when fever free for 24 hours and you know or do you think that we’ll maintain this intense approach of keeping kids out for five to 10 days every time? And maybe.
Speaker 1 55:16
Yeah that’s a great question. So yes, I do think eventually it will become like the flu. Already the intensity of guidelines have changed quite dramatically, you know, over the last two years and even in the last year, I would say not just for kids but for everybody. So I think again, as we understand more about the virus, as you know, we have more therapeutics, more individuals, especially children have access to the vaccines, it will definitely change and i think it will become. Less than 10, you know, and hopefully when newer viruses emerge, we’ll be much better equipped to deal with pandemics like this so we don’t have to go through a similar experience again.
Speaker 2 55:58
And I know I said that was going to be the last one, but this has come up multiple times and we do have just a minute. And so there is this rumor that the booster isn’t as effective for the new variant after Omicron. What is your belief about that?
Speaker 1 56:15
Yeah, I mean that’s a great question and one you know as each new variant comes right, remember this vaccine is still the same vaccine that first came out. So it was studied on the original or wild type form or the virus you know pre most of these variants. So yes, I’m not surprised it may not be as effective for the newer variants that emerge, but at the same time if it does add an extra layer of protection. Against that severe disease death, yeah, in the very high risk populations or other populations, it’s still the best tool that we have. But on the flip side of it, I know virtually every country company, sorry is studying variant specific boosters. So I’m hoping we’ll have something that’s more targeted, more effective as these newer boosters involved. And there’s also some data as I mentioned with the Novavax vaccine that it may have pretty good efficacy. Omicron and it’s newer variants from what we’ve seen, but you know the FDA is currently still reviewing it. So there are other options on the horizon. But until then if you’re somewhere that these boosters are recommended, please take it because there is still benefit. It does still stop new infections and the severe infections and death.
Speaker 1 57:38
And I want to thank each of you for just these questions. I mean there are still dozens and dozens of questions which shows the need for why we’re continuing to do these COVID webinars on a monthly basis. I want to thank Doctor Parikh for her expertise and for continuing on this journey that we never dreamed with last two plus years. As we turn to our next webinar, please mark your calendars for Thursday, May 26th. We’ll look at access and equity and. Asthma care with Doctor Bridgette Jones, who is a specialist specifically on that topic. And you can register for that webinar on our homepage at allergyasthmanetwork.org at the bottom of the page, where you can register for all of our webinars. Again, we look forward to having you join us, and we do ask that you remain online to complete that evaluation survey. Thank you so much for your time today. I’m Tonya Winders on behalf of the staff at Allergy & asthma network. As we continue to learn more about COVID-19 through the lens of science, we can all breathe Better Together. Thank you and have a great day.