This webinar was recorded on Thursday, September 15, 2022
Join our Network experts for the latest news and information on COVID-19. We’ll discuss rebound infections, Long COVID and the newest CDC guidance all with time to answer YOUR questions.
Speakers:
- Dr. Purvi Parikh
- Tonya Winders, Allergy & Asthma Network President & CEO
Resource:
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 1 (00:01)
We’re pleased that you have chosen to join us today for our 39th webinar in our COVID-19 series. We’re proud that there have been over 75,000 views of our webinars that bring you the latest evidence based on information on COVID-19 over the past two and a half years. Today’s session is COVID isn’t over rebound infections, new guidance and more. Allergy & Asthma Network lives out our mission every day to serve to end the needless death and suffering due to asthma, allergies and related conditions through our four mission areas outreach, education, advocacy and research. Again, this webinar series helps us to achieve that mission as COVID is one of those related conditions that we focused on over the last two and a half years. Today we welcome our COVID-19 medical expert, Dr. Purvi Parikh for the webinar. Most of you know Dr. Parikh, but I’ll share a bit about her. She is an adult and pediatric allergist immunologist at Allergy and Asthma Associates of Murray Hill. She’s also currently on faculty as clinical assistant professor in both departments of medicine and pediatrics at the NYU School of Medicine in New York. She’s been passionate about health policy and serves on the board of Directors of the Advocacy Council for the American College of Allergy, Asthma and Immunology.
Speaker 1 (01:38)
Dr. Parikh is the spokesperson for Allergy & Asthma Network and frequently makes appearances as the medical contributor on our behalf to NBC, Fox, CNN, Wall Street Journal and CBS, CEO of Allergy and Asthma Network and the current president of Global Allergy and Airways Patient platform. And it’s our pleasure to be your speakers for today. So first let’s take a look at our agenda and our objectives for the program. We’ll take a look, as we always do, at the current state of COVID-19 here as of September 15, 2022. And then we’ll spend some time really talking about what is a rebound infection of COVID-19 and also providing a long COVID update. And then finally we’ll wrap up with new information and guidance from the CDC as we move forward. So, as we get started, let’s go ahead and take our first poll question. Which category best describes you? I’m going to ask that Sally launch that poll and you guys go ahead and put in your response. So which category best describes you? Are you a physician? Physician assistant? Nurse practitioner? Nurse school nurse? Respiratory therapist as an educator, health educator, patient caregiver? So we’ll give it just a moment, let everyone log in their responses and then we’ll share collectively who is around the table.
Speaker 1 (03:14)
It’s so encouraging to us and appreciate all of you being here, your time and willingness to continue on this COVID journey with all of us. Today. We have about 1000 people registered, over 1000 people registered for the webinar. And so we’ll give the system just a minute to record. Looks like we’ve got about 69% school nurses, nurses, 19% RTS, asthma educators, health educators, 7% patients and caregivers and 5% physician, physician assistant nurse practitioners. Thanks, Sally. So let’s move on. So now we’ll take a look at the latest data on COVID-19. If you’ve been with us before, you know we like to go to the Johns Hopkins COVID-19 dashboard, which again records globally the number of cases as well as total death toll. Now again, we still anticipate that some of these numbers are likely underestimated given the amount of home testing, given the amount, of the fact that in not all countries we’ve got great reporting. But where the numbers sit today and that this is the most reliable data in the world, is we’ve got over 610,000,000 cases of COVID that have been confirmed with over 6.5 million total deaths across the world. And again, you can see where those deaths are by region, by country, and with the highest amount being in Japan and South Korea and then the US in the third position as far as the overall 28 day case rates and the trends that we’re seeing across the world. This also tracks vaccines. And so it’s great to see those vaccine numbers continue to increase as well. Now, the CDC data, again, this is the US data a little lagging behind the Johns Hopkins data, but this shows us the darker the blue, the more current cases of COVID-19 in the US. And so we can see that, again, there are pockets throughout the south and the Southeast specifically, where the rates have been higher, as well as in Virginia, in South Carolina. And then, interestingly enough, we are still seeing an increase in cases in some of our territories as well. So what about the headlines? Again, it’s always helpful to kind of take a step back and see what the news is telling us. Although it’s not dominating the headlines, there’s still a lot of COVID news on a weekly and certainly on a monthly basis. So the headlines this month tell us that there are COVID emergencies that are being lifted throughout the country. We’ve seen the New York governor allowing that COVID-19 state of emergency to expire as cases continue to decline in that state, which is the state that Dr.Parikh is in. So we’ll get her perspective on that. And then we’ll also note that Washington state’s governor has announced the upcoming rescission of all remaining COVID-19 emergency proclamations in that end of the state of emergency there in the state of Washington by October 31. So it does seem like some of those governmental restrictions and directives are being let go at this point. Also, when we look at the headlines, we’re seeing more and more cases, unfortunately, of long COVID. And again, remember that symptoms that last more than six weeks post the acute infection. And what we’re seeing here is psychological distress, including depression, anxiety, and worry, perceived stress. Loneliness before the COVID-19 infection was really associated with, kind of, just this increased risk of long COVID. But now, according to those researchers at Harvard, we’re seeing that increased risk was independent of other comorbid diseases, of other high risk behaviors like smoking, asthma, and other physical conditions. And so, again, long COVID is wearing its toll on so many millions of people across our nation who are continuing to struggle with the mental health effects as well as the physical health effects. And what is the World Health Organization saying?
Speaker 1 (07:46)
So WHO actually released its policy briefs this past week that outlined key actions for governments to take to end the pandemic. And the WHO Director General had this quote around last week: the number of reported weekly deaths from COVID was the lowest since March of 2020. We’ve never been in a better position to end the pandemic. We’re not quite there yet, but the end is in sight. And he gives this analogy of the marathon runner who doesn’t stop when the finish line is in view. They continue to run harder with all the energy they have left. Again, that’s sort of where we are. We can begin to see the finish line. We know that this is somewhat our next normal or new normal. We’re in that winning position when it comes to COVID-19, and we just have to keep working towards that finish line, that crossing the line and reaping the war rewards of all of the hard work of public health officials and frontline healthcare workers across the world over the last two and a half years. So now let’s go to our second poll question. How many times have you been tested or performed a home test for COVID-19?
Speaker 1 (09:02)
So I haven’t been tested at all one to five times, six to ten times, or more than ten times. Again, we’ll give everyone just a moment. I know myself. When I had active COVID, I had to test multiple times. And as my travel has picked up, I’ve had to test multiple times. So I’m probably on the high end of this at this point, unfortunately. But it is becoming sort of second nature. You are getting ready to go to a big event or you’re getting ready to travel. It’s a good idea to test and know for sure. All right, let’s see. So it looks like 49% of the audience has had one to five times of testing. 19% say up to ten times. And then 25 of us, 25% of us more than ten times, with only 7% not having any tests. And they’re, they’re the fortunate groups that have had no symptoms and no need to test over the last two and a half years. So let’s take a look here at the trend line of the COVID-19 cases. And again, you can see that peak in the late 2021 period as the height of daily trends.
Speaker 1 (10:19)
But now we are very much at that low level and on the downward spiral of this last drain of COVID-19 that we again was so virulent that we saw so many more cases. And so we’re back at those levels of kind of July 2020, right around that same time when it seems like a very long time ago. But certainly I think we’re seeing that downward trend, which is a positive thing. So now I’m going to turn it over to Dr. Parikh, and she’s going to COVID rebound infections and the long COVID update.
Speaker 2 (11:00)
All right, thank you very much. So we’ve been hearing this term quite a bit about COVID-19 rebound infections, and I think there’s a lot of confusion surrounding the term as well. And I think it’s good we’re going through it, because I think it gives people a false sense that maybe certain therapeutics aren’t working or medications aren’t working. So what rebound is, is that it’s a resurgence of symptoms between two and eight days after initial recovery and recurrence of the COVID-19 symptoms, or a new positive viral test after having been tested negative. So that brief return of symptoms may be part of the natural history of the SARS COVID Two virus, the virus that causes COVID-19 in some people and independent of treatment with Paclivid and regardless of vaccination status. That’s a very important point, because I think the media has painted it as something that’s being caused by Paxlovid, or might be caused more so in either vaccinated individuals or unvaccinated. So I just want to set the record straight is that we saw rebound happen all the time, even before there was an available vaccine or even before Paxovid was available. That’s just how this virus is.
Speaker 2 (12:18)
We see it last not only a long time before and after the infectious phase, but also we do see this resurgence even back in 2020. And the information is limited. Remember, even though this pandemic feels extremely long, it’s been under three years that we’ve really been dealing with it. So we’re still learning a lot, just as we’ve been saying throughout this entire thing, we’re learning as we go. And we have case reports that suggest that people treated with PaxloVid who do have this rebound have a mild illness. Most notably, Dr. Anthony Fauci was one case. President Biden. There’s no severe illness cases, which is good, and there’s no evidence that additional treatment is needed with taxovid or other therapies where rebound is suspected. Now, the FDA has asked Pfizer to look into whether certain individuals might need a longer course of Paxlovid. So elderly immunocompromised, because they might be at a higher risk for rebound or might have higher viral loads or immune systems might not be. So that may evolve. But as of now, we aren’t necessarily treating people for longer unless clinically there’s a reason to do so. And the risk of transmission can also be managed by following the CDC’s guidance on isolation and taking other precautions like masking.
Speaker 2 (13:44)
So the same rules apply if you’re testing positive on those rapid tests. If you’re symptomatic, please stay home and isolate. That’s a good rule of thumb for any infection, not just COVID. And so some of the characteristics, as we said, symptoms come back after they’ve seemingly gone away, a new positive viral test after having tested negative. And then again, these patients again should isolate, follow CDC recommendations whether or not you had an antiviral like Paxlovid or not. And then again, you can end your re isolation period after five full days of that resurgence of symptoms, and also after that fever has resolved for at least 24 hours. And then isolation again should be restarted, like we mentioned, and people should wear a mask for a total of ten days after rebound symptoms have started to protect those around you. And that’s all based on the recent guidelines and evidence. So some PCR tests, other tests may stay positive past those ten days, but those ten days are really when the viral shedding is the highest. So, based on the information from case reports, again, the rebound did not necessarily mean it’s a reinfection or resistance to Paxlovid.
Speaker 2 (15:07)
Again, it’s just the nature of the virus. And one thing I think people may not understand, unless you work in health care, is that often when you do tests while on antivirals or on antibiotics, they can become what we call falsely negative, because that medication is actually suppressing the amount of virus or bacteria or what have you circulating in your blood. That’s why we try even to do bacterial blood cultures on patients before starting antibiotics, because for the same reason. So it’s not necessarily went away and came back. It just may have become undetectable. While on the actual medication, they didn’t find other respiratory pathogens and people who had those rebound symptoms. And again, there is transmission anytime you’re symptomatic. So the great rule of thumb is if you’re having symptoms, please isolate yourself and stay home. That’s the safest way to proceed next. Right, so a look at Paxlovid antiviral therapy. So, Paxlovid continues to be recommended for early stage treatment of mild to moderate COVID among those individuals who are high risk for progression to severe disease. And it does help prevent hospitalization and death. Again, it’s under the Emergency Use Authorization for age twelve and up.
Speaker 2 (16:25)
It’s an antiviral pill which is taken at home. This has been a huge game changer, especially in my practice. I’ve prescribed it almost daily for the last three to four months. And it’s just so nice to have this option because now we’re able to manage the majority of COVID-19 at home and we have so many more tools in our tool belt and we can really nip it in the bud because you have to start it right away within five days of developing symptoms. It’s three pills twice a day for five days, and there’s an 89% reduction in hospitalization. So far, it’s working well against the Omicron variant, and ideally it shouldn’t be for everyone, right? It’s for those individuals who have the underlying conditions were the highest of risk, because it has a long list of side effects and a lot of drug drug interactions. But luckily, overall, most people have done quite well and then some just kind of rebound. Recommendations for healthcare Providers again, no additional treatment is needed. Follow the CDC guidelines about five days of isolation and masking for ten days. Consider clinical evaluation of patients if symptoms persist or worsen, because then something else may be going on or they may be getting worse.
Speaker 2 (17:44)
And then providers are encouraged to report these cases of rebound to Pfizer after treatment with Paxlovid. And we’ve seen some of these cases even occur with the monoclonal antibodies as well. So that’s another great outpatient option that’s now much more readily available than it was even six months or a year ago. So talk to your doctor or health care provider if you’re at increased risk of developing severe COVID. If you get sick or you get these rebound symptoms. Consider requesting PAX of it or another treatment like the monoclonal antibody if you meet the eligibility criteria. And contact your doctor or healthcare provider if the symptoms get worse or persist. Now, luckily, things are very readily available and you don’t have to suffer, especially if you need a higher level of care. You should never wait in seeking medical attention and then find evidence based answers to your questions. There’s a lot of misinformation everywhere you turn, so make sure that you are getting accurate information because you might be missing out on something that’s a safe and effective treatment due to misinformation and important things about long COVID. Now, once we move past the infectious stage, unfortunately, many individuals are suffering six months later, a year later, or more.
Speaker 2 (19:12)
This is a post COVID condition that can include a wide range of ongoing health problems, and these conditions can last weeks or months or years, and often it’s found in people who have severe COVID-19 illness. But to be honest, we’ve seen it across the board. So even people who have had mild symptoms or no symptoms have gone on to develop long COVID, which is a bit disconcerting. People who are not vaccinated against COVID-19 and become infected are also at higher risk. So many patients were seeing from those early days, unfortunately, before those vaccines are readily available. And interestingly enough, there’s some data, and Yale is doing a study on this, that the vaccines and some people help their long COVID symptoms. There is a group where the vaccines sometimes make it worse, but it’s interesting that some people are getting better after the vaccine, so that’s being studied as well. So while most people with post COVID conditions either have evidence of infection or COVID-19 illness, in some cases people with these conditions may not have tested positive for the virus or even have known they were infected. Maybe they were asymptomatic carriers. So the CDC NIH virtually every medical center across the country are working, kind of, to understand who experiences it.
Speaker 2 (20:33)
What makes people high risk, which groups might be disproportionately impacted by Long COVID? So the symptoms, they can be anything and everything. There used to be an old saying that TB presents any way that it wants. I feel the same way about long COVID. So general symptoms are tiredness, fatigue. Fatigue is probably the most common thing I hear from patients. It really interferes with daily life symptoms that get worse after physical or mental activity. Sometimes even fevers can persist. There can be difficulty breathing, shortness of breath, chest pain. Neurological symptoms are extremely common. Brain fog, headache, cognitive issues. Many patients report memory issues, trouble concentrating on tasks that are very simple, like watching the TV or work, tasks that used to be very simple and easy for them to do. Dizziness, change in smell or taste, and a whole new onset we’re seeing of psychiatric and mental health disorders, depression, anxiety. There’s even been some cases, very sad, of Long Covid patients committing suicide. So it really affects every organ system, digestive symptoms, diarrhea, stomach pains, and then a lot of joint pain, muscle pain, rashes, changes in the menstrual cycle as well. So what is the CDC doing to learn about these post COVID conditions?
Speaker 2 (22:17)
Obviously, a lot of research is going into this. There’s been a lot of funding as well from the government that’s been going into studying long COVID, because if you can wrap your head around it, we’ve had 1 million deaths in this country alone from COVID-19. But that is a small proportion compared to the individuals who had COVID survived and now are suffering. So you can just imagine how many millions of people are dealing with this on a daily basis. So we really need to understand, identify risk factors, which groups are disproportionately affected, and then the burden, which I think is going to be immense, both financial and health wise, people already are getting very expensive workups because they have to see literally every specialist to address all the symptoms from the previous slide. And often the workups are unrevealing. So there’s a huge impact on the healthcare system. And of course, your health, which is most important, is also a significant burden significantly in this time. And then we need to find successful interventions, whether that be therapeutic or otherwise. Is it vaccinations? Is it medication? And we have to make sure we have equity in healthcare access and utilization as well.
Speaker 2 (23:33)
Often these patients are left fending for themselves. So it’s important. And CDC is also looking at how to disseminate the clinical guidance and education materials as well and kind of reduce the stigma around it. Excellent. So the vaccine, this is very important. This is a nice map that I really like that shows the vaccine coverage in the US. I was told by our vaccine center, the chief of our vaccine center that was participating in some of these trials, that this is actually the largest global vaccine campaign in history. We’ve now crossed, I believe, over 6 billion vaccines globally. So it’s quite amazing, the vaccines by type. It varies, obviously, country to country. But here in the US, by far Pfizer is the most commonly used, followed by Moderna and then J and J Nova vaccine. This makes sense. Pfizer was the first approved, but that may shift now because as we know, COVID is here to stay and there’s still other vaccine modalities that are yet to be approved. So the CDC director, Rochelle Wolinski, basically endorsed the advisory committee, the ACIP, to basically for updated COVID-19 boosters for people aged twelve and up, and also for those 18 and up.
Speaker 2 (25:07)
So these are what you’ve been hearing about the last few weeks, the Bivalent boosters. What Bivalent means is it contains immunity to the new strains of Omicron such as BA Four, BA Five, cyc protein, as well as the original virus, which many of us already received vaccination from. So by doing so, the idea is that you will be better protected, especially as we move into these fall and winter months. And this is the first vaccine that’s really been updated with the newer variants. So it’d be interesting to see, hopefully this will kind of restore protection, will hopefully give rise to less variants now and then also will cause less waning of that vaccine immunity in the face of other variants. The FDA has also authorized it as well. So what is in it? Just briefly. As I mentioned, it’s bivalent. It’s the same exact technology as the original mRNA vaccine, which I mentioned has been given out to billions of individuals, no longer experimental. I just want to make one point. I know I get a lot of questions that this was approved on animal studies and the human trials are still underway, but that’s actually nothing new.
Speaker 2 (26:27)
That’s how our annual flu shot is approved. And the important thing to note is there’s nothing new about this technology. It’s the same mRNA technology, it’s just that now it has that extra protection against the newer variants and again, they can be used as a booster shot at least two months after your last vaccine. This isn’t meant to replace initial vaccinations. So if you’re not yet vaccinated or partially vaccinated, you should complete the primary series first and then go on to this booster. And then some notes on the side effects. So the side effects are not expected to be much different. Now the vaccines have been out for about two weeks, so many individuals have already received it, including some of my patients, family members. I’m getting it this weekend. So the side effects are pretty identical to the other vaccines; expected headaches, muscle aches, fever, and then Dr. Paul Offit, someone who I really respect, the director of the Vaccine Education at Children’s Hospital of Philadelphia. He also agreed that we don’t have full data on this yet, but biologically and immunologically it doesn’t make sense that their side effect profile would be very different. And we are seeing that it is very similar.
Speaker 2 (27:48)
And Dr. Willinski, when she approved it, said that the updated COVID-19 boosters are formulated to better protect against the most recently circulating variants and they can help restore protection that has waned since previous vaccination. And they’re designed to provide broader protection against the newer variance. And this recommendation, again, is not made lightly. It’s following a comprehensive scientific evaluation and robust scientific definition. So if you’re eligible, definitely go ahead and get it. That’s what she recommends. I recommend the same. So new CDC guidance has also come out in the last few weeks. So the CDC is trying to streamline their COVID guidance to help people better understand their risk, how to protect themselves and others, and what actions to take if exposed. They describe what actions to take if people are sick or test positive to the virus. And with so many tools available to us for reducing COVID-19 severity, there’s significantly less risk of severe illness, thankfully, and hospitalization and death compared to earlier in the pandemic. And of course, we’re in a much better place than we were before. I completely agree with Dr. Macedi’s statements as well. We understand the virus better. We know how to protect people.
Speaker 2 (29:16)
We understand transmission better. So I know that the title of this talk may be discouraging, that COVID is not over, but we’re much better equipped to fight it. So it actually is uplifting in a way. So defining isolation and quarantine. I know this is always very confusing, especially when CDC releases new guidance. So basically it relates to how your behavior should be after you have a confirmed infection. So isolation for five days is still recommended, followed by wearing a well fitting mask to minimize the risk of infection of the virus to others. And that period is for ten days. So you, even, after your isolation, you should continue to mask because you’re still shedding the virus. And then quarantine refers to time following exposure to the virus or close contact with someone known to have COVID-19. And this guidance comes as the Omicron variant continues to spread throughout the US and reflects the current science on when and for how long a person is maximally infectious. So again, this is a great slide that kind of breaks it down very easily, because if you go to the CDC website, even me as a physician, I found it very confusing how they had it written.
Speaker 2 (30:41)
This I like. So, you get the Omicon variant allows us to shorten the recommendation time for isolation of the public. So again, isolate for five days. If asymptomatic or symptoms are resolving, continue to isolate, but then follow up with that mask for another five days afterwards a total of ten days, you should be wearing a mask, especially around others. And again, this is all data driven because we know when the transmission is highest, when you’re most infectious, when that viral load is the highest, and then quarantine for exposure to COVID This is important because it varies whether you’re vaccinated or not. So people who are unvaccinated or are more than six months out from their second mRNA vaccine, or more than two months out from the J and J and haven’t been boosted, these individuals should quarantine for five days, followed by strict mask use for an additional five days. So this is even whether or not you’re positive. So that’s the difference. So the initial last slide was if you know you’re positive, definitely isolate five days and then mask for that full ten. This is exposure and that’s where your vaccination status makes a big difference.
Speaker 2 (32:02)
Alternatively, if a five day quarantine is not feasible, it’s imperative that that exposed person wear a well fitting mask at all times when around others for ten days after exposure. Individuals who have received their booster shot do not need to be quarantined following that exposure, but should still wear a mask for ten days after the exposure and then for all those exposed. Obviously, it’s common sense. The best practice should also include that test at day five because we have so many cases. Day one you test negative, and then day three, four, five, the test comes back very positive. So just remember, there is a trajectory to that viral load and if symptoms occur, individuals should immediately quarantine until a negative test confirms that symptoms are not attributable to COVID-19. Vaccine is the best way to protect yourself and reduce the impact of COVID-19 on your communities. The vaccines are very effective. The effectiveness from two doses, I know this looks low, says about 35%, but what that means is it actually is much more effective in preventing death and hospitalization. So even though people are falling ill, they are in a much better state than they would be.
Speaker 2 (33:24)
And then that effectiveness goes up even higher with the booster dose. So when we look at effectiveness, that’s actually just the infection itself. So it doesn’t take into account, if you end up in the hospital, how severe it is. So don’t be fooled by those numbers. So again, the fact that it’s keeping people from passing away, keeping people out of the hospital, shows that it’s extremely effective. And those percentages are upwards of 80% to 90% effective. And then that rises again with the booster. So it really is crucial to decrease that risk of severe disease, hospitalizations, death and long COVID. So your recovery is much better as well. So again, I know we sound like a broken record, but we just want to make sure everybody is clear because these guidelines can be confusing. So if you’re positive, stay home. It doesn’t matter how many vaccines you’ve had for five days, and then if you know symptoms or the symptoms are almost gone, then you can break isolation with. The mask for another five days, keep that mask on. But if you have a fever, obviously that still counts as a symptom. So keep staying home until the fever goes away.
Speaker 2 (34:38)
And then again, if you were exposed to someone with COVID-19 but you’re not vaccinated, you still have to isolate for those five days and wear the mask. But if you haven’t had that, if you’ve been vaccinated or boosted or it’s been a long time since you’ve had at least six months or more since your last vaccine dose, still quarantine yourself, test yourself on day five, wear a mask again around others. And then this is only to basically protect the people that you care about, not trying to inconvenience anyone. We want to keep everybody healthy so we don’t move backwards and we keep moving forwards. So again, just make sure that that’s why that vaccination status is so important and that’s why, you know, so it’s just a quick rule of thumb, five days at home and then ten days for the masking. Okay? So if you did have a moderate severe illness or have a weakened immune system, please talk to your doctor before ending isolation because in those individuals, they’re more prone to rebound of the symptoms or prolonged symptoms. So they may need further guidance. Again, if the symptoms worsen or restart, you cannot end isolation because you’re still contagious.
Speaker 2 (36:02)
Screening, of course, is important. The distancing is still very important. And maintain that 6ft or more as much as possible in addition to the masking. So, medications to treat COVID-19, as I mentioned earlier, we’re in a much better place than we were a year ago, two years ago. So we have Molnupiravir and Paxovid, which is a mix of two antivirals nirmatrelvir and ritonavir. And we also have remdesivir for our admitted patients monoclonal antibodies that are also available to treat COVID-19 in people who are at high risk for the illness, who may not tolerate the antiviral pills. And this is older adults, unvaccinated individuals, those with certain medical conditions. All of these individuals now have so many options to keep them out of the hospital, which is wonderful. And again, these antiviral agents, they reduce risk for hospitalization and death when administered. And what I’ve noticed just from my own patients is they also reduce the duration of the illness. I found that the patients that took Paxovid or Molnupiravir versus not or took a monoclonal versus not, they actually had a resolution of their symptoms much faster too, and a much milder illness, which makes sense.
Speaker 2 (37:25)
And recent expansion of prescribing authority of Paxlovid as a pharmacist intends to hopefully further facilitate access. But again, we need to make sure that there’s none of the racial and ethnic disparities in receipt of these monoclonal therapies and antivirals. We want to make sure that everyone has equal access to all of these therapies. So as the virus continues, as we said, it’s not over. And I can attest that we’ve been diagnosing it on a daily basis. It’s really important that we stay ahead of this. So the current focus is on reducing very severe illness, death and health care system strain, and those are appropriate and achievable aims by what we’re doing. So it’s really shifted from the early days where it was mostly an inpatient illness and now it’s mostly an outpatient illness. Hopefully it stays that way, especially as we go into the winter flu and pneumonia season. And the rapid identification of emergent variants is very important. So that way we can quickly adapt our strategy, our vaccines and our therapeutics as new information becomes available, as what happened when the Amicon variant broke around Thanksgiving time last year. Next slide. All right.
Speaker 2 (38:50)
And then with that, we’ll go on to the poll question. Are you planning to get the new Omicron variant vaccine booster shot? And I can’t answer the poll officially, but I am.
Speaker 1 (39:03)
Me too. Again, if I had the mild version, because of being fully vaccine boosted, I don’t want anything to do with the more severe in the absence of that booster. So I’m with you, Dr Parkih, right?
Speaker 2 (39:20)
I feel the same way. I don’t want any form of it. All right, so it looks like the majority is planning to get the Omicron variant vaccine booster shot, which is good. It’s in line with the CDC recommendations. Some are undecided, some decided not to, which is fine. It is a personal choice. But again, make sure you are receiving evidence based and correct information when you make your decisions.
Speaker 1 (40:01)
Great. Thank you so much, Dr Parikh, that was fantastic. We so appreciate your continued commitment to working with us as you deliver such valuable, needed information on COVID-19. So now let’s go to your questions, if you will, please write them in the question box. We’ll get to as many as possible before our time exhausts here this afternoon, and I do see a few questions already in the question box, so I will go to the first one. This is a question from Jill, who says, I remember back in the days of Delta, if you got COVID, it could be followed by, quote unquote, sort of a honeymoon period where you had great protection against reinfection for like 90 days. I’m thinking the same is not true for Omicron, but if you could speak to that, please.
Speaker 2 (40:52)
Yeah. Unfortunately, what we’re seeing is that with the newer variance of Omicron BA four, BA five, we are seeing reinfections. That’s the problem with newer variants, they become smarter at evading our own immune system. So that’s why we are still recommending that even if you had the natural infection, it’s good to have natural immunity, but you should still get the vaccine immunity too, as an insurance policy or backup plan, because especially with the newer variants, it’s not the same as Delta. Unfortunately, people are getting sick again.
Speaker 1 (41:28)
Yeah. And we are hearing so many more reinfections with this strain and this variant for sure. The next question. So if your first two vaccines and your booster were Pfizer, do you recommend getting the updated pfizer, second booster or moderna, or does it really matter?
Speaker 2 (41:47)
Oh, that’s a great question. I’ve been getting that a lot. So the short answer is it doesn’t matter. The best vaccine is the one that you can get the soonest. So they’re both great. There’s a slight difference in dosing, as there is with the original pfizer. Moderna shots. The Pfizer is 30, micrograms Moderna is 50, but otherwise it doesn’t matter. And it’s perfectly safe to mix and match as well.
Speaker 1 (42:13)
Okay, I think this next question is so great and something that has been confusing for myself as well. So would you speak to the term, quote, fully vaccinated versus the term up to date? Because both terms are being used and it can certainly be confusing when you’re filling out questionnaires.
Speaker 2 (42:34)
Yeah, I agree. Actually, I think they need to update what fully vaccinated means, to be honest, because according to the CDC, fully vaccinated is just the first two doses. Interestingly, doesn’t include the boosters. However, if you look at the guidelines that we just went through, they’re updated guidelines. That distinction is very important, too, when you had the last shot. It was within six months. So I think up to date is probably the correct term, but it really should be one and the same. So up to date and fully vaccinated should be the exact same if it were up to me. And I think that has to be changed at this point.
Speaker 1 (43:17)
Absolutely. Now, an important question here from Eileen. How long are the booster shots lasting? So how long is that protection that we know today?
Speaker 2 (43:31)
Yeah, I can’t speak on the newest booster, the Omicron bivalent one because it literally was just approved. But the other boosters shot number three or four that most people got prior to this in the last year, there’s different reports. Again, this is my issue with how the media reports things. There’s a lot of talk of vaccine immunity waning after six months or eight months, but there’s actually a lot of data that shows that what they’re talking about is only you’re circulating antibodies and there’s so much more to the immune system. All of us have T cells that are very important in fighting viruses, and that’s really what keeps us out of the ICU and out of the hospitals. And there’s been numerous studies that show that T cell immunity actually has been long lasting even with just the first two shots. So I believe both the boosters are very long lasting. The issue is with the newer variants, right? So they’re still able to cause milder infection. So we want to get to a point where that doesn’t occur as well. The antibodies continue to be strong and the T cells do. So I think there’s been a lot of misinformation that the boosters aren’t working.
Speaker 2 (44:46)
And I think that’s why some people might not be getting more. But I think that’s the wrong message that’s been out even for your first shot is likely still giving you immunity. Still. Now, it’s just that we want to get to a point where there is very little infection, let’s put it that way, like it is measles or other illnesses.
Speaker 1 (45:06)
Right. And, you know, I think that this is an important point too, because so many times we think, oh, well, getting vaccinated or getting boosted means we won’t get infected, which is absolutely not the case. Right. And the vaccines, as we have said time and time again that we have to keep reinforcing, really are to protect against severe symptoms that end in hospitalization or death, right?
Speaker 2 (45:34)
Correct.
Speaker 1 (45:35)
All right. Now we’ve got a question from Krista who says, I’m an elementary school nurse and really curious about long COVID and rebound infection numbers in school age children. Any data that you know of?
Speaker 2 (45:47)
Yeah, luckily it’s much less than an adult, but it is out there and we have seen pediatric patients affected. It can be obviously very disconcerting because we don’t really know what at least in adults or children, we don’t know the long term effects even of long COVID. Right. And especially in children who are still developing, have developing immune systems. This is why, even though many naysayers of the pediatric vaccine say, but COVID isn’t that severe in kids. I’m like, yeah, but you don’t really know, severe or not, what those long term implications are. Luckily, it is much less so. That’s true. It’s probably less than 25% of children go on to develop long COVID, which is very different than their adult counterparts. But again, my worry is we don’t know what that means, like developmental, because there are certain viruses like measles, where the complications don’t manifest for 30 years later. Right. I think that’s another strong case for the pediatric vaccination, even though the uptake hasn’t been that great.
Speaker 1 (46:59)
Yeah, absolutely. I think there is, again, if only we had a crystal ball and if only it would work, we would be able to answer so many of these questions. But we don’t know. And so we just have to go with the best science, we have to go with the latest expert opinion. And certainly I think that be as cautious as possible and proactive as possible. Now, this next question comes from Gary, who says, is there evidence to inform us which mask type is best to wear?
Speaker 2 (47:35)
That’s a great question. So what we’re finding is a lot of the cloth or homemade masks are unfortunately not as effective with the newer variants. Of course, any mask is better than zero masks. So I’m not saying don’t mask at all if you have no other options. But usually we’re finding the medical grade masks are far more effective. So ones that are more tight fitting KN95 N95, even though they’re very uncomfortable to wear, even surgical masks can provide you with some good protection as well, especially if you do decide to double masks. So I would opt for some of those medical grade masks. The fit is also very important. Make sure it’s well fitted around your nose and mouth. But again, a barrier is always good. So, again, I know there’s a lot of misinformation masks don’t work. I don’t agree with that because it’s just common sense. If you have something on, there’s less particles that can get through. But, yeah, I would opt for one of the higher quality medical grade max.
Speaker 1 (48:39)
Great, thanks. This next question comes from Kendall, who says, when should you get a booster after having acute COVID infection?
Speaker 2 (48:48)
Right. So currently the recommendation is you can get a booster once you’re feeling back to normal and feeling well. Again, if you’re still dealing with the infection, obviously don’t get the booster at that point. The only catch is if you’ve had a monoclonal antibody treatment during your COVID infection. So then you should wait 90 days. But if you weren’t treated with the antibodies and you had Paxyl Van or other treatments, then you can go ahead and get the booster once you’re feeling back to yourself.
Speaker 1 (49:20)
All right, so we have several comments and questions from school nurses who are sharing that. Unfortunately, their state departments of education are no longer recommending any quarantine. If you are a school nurse and in that position, how might you respond to that? Dr. Parikh?
Speaker 2 (49:40)
Okay, well, that’s surprising, especially given the CDC recommendations are recommending the five days. And that’s probably how I would respond, that the recommendations are made based on science, and that five day, at least initial period, should be followed. And if the child can’t follow that for some reason, I don’t see why not. But then that well fit. That child has to be masked for ten days if they do come to school, and that’s based on the science and the official guidelines. I’m surprised that the state departments wouldn’t be following those guidelines.
Speaker 1 (50:15)
Okay. And again, we’re hearing reports from different parts of the country where it is varying. But I think that you’re right. Just sending back over some of this evidence based approach and documentation from CDC and other well respected entities I think would be helpful in moving that forward. Our next question comes from Ellen Kay, who says, so is it to isolate for five days and then mask for ten days, or is the isolation included in that total ten days of masking?
Speaker 2 (50:52)
Yeah, that’s a great question. So the isolation is included in the ten days of masking. So it’s five days of isolation and then another five days. But the only caveat of that is if you get that recurrence of symptoms, let’s say you finish the five days, and then you move on to the isolation period, and then you get rebound symptoms, then you have to restart that isolation period again from day one or day zero. And if you’re still having fevers, then you have to keep isolated while you are having fevers. You have to be fever free for at least 24 hours before you can go into the masking phase in public.
Speaker 1 (51:31)
Very helpful. Now, I think this is also a really fascinating question from Julie, who says, do we know why people with long COVID? Are we testing them in any way to understand their shortness of breath or cough? Are we doing like, PFTs, cardiac testing, CT scans, any data that you’ve seen around those types of tests on long COVID?
Speaker 2 (51:59)
Yes. And so the answer is all of the above. And that’s why we were mentioning how this is going to be a large, and already is a large, financial impact on the healthcare system because all of these patients have received all of these tests or are receiving them. So they all get a full pulmonary work up with Cat scans, breathing test full, and most of the time, nothing is found. Very rarely. Sometimes we’ll find, like a blood clot or something that can explain it well, but the majority of the time, there’s nothing. So that’s why it’s so puzzling and we think we don’t know what’s causing it, but a few theories are. One, there’s just persistent inflammation that’s been left behind by the virus. And that inflammation is causing inflammation of your chest wall, of the muscles, around your lungs, the nerves. We think there’s also a lot of blood vessel inflammation as well. There’s evidence of that that multiple laboratories have found. And another thought is that this is like almost an autoimmune condition, basically, that there might be residual pieces of the virus and your immune system is kind of revving up against that, even if you’re not contagious anymore.
Speaker 2 (53:11)
So, unfortunately, those inflammation, you can’t really see a majority of these tests. Even in breathing tests, you can, but only certain types of inflammation, like if you have asthma or COPD or something else. So, yeah, unfortunately, all these patients get all of these tests, but they don’t really help for most of them.
Speaker 1 (53:30)
Yeah. So we have time for maybe one more question, and it’s come up several times in the chat. So if I got boosted in August, do I need to now get the new Omicron variant booster as well?
Speaker 2 (53:48)
Yes. So the current recommendation is two months from whenever your last booster was. But if you’re low risk, you may want to discuss with your doctor what’s best for you. There is some thought that if you do the boosters too close to one another, they don’t have as good of an immune response because your immune system kind of gets used to seeing it. So I definitely wouldn’t do it sooner than two months. And between two to four months, to me as an immunologist, makes the most sense because that way, at least you have a little gap and you’re still protected for that winter respiratory virus season. Before we know it will be here, we’re already seeing cases of other viral infections going around.
Speaker 1 (54:36)
Yeah, absolutely. I see. One question that we should address, because we’re headed into what’s called the asthma peak week, right, the third week of September week. And there are a few questions about neb treatments. Nebulizer treatments. In the last couple of years, we said try to avoid nebulizers at all costs, part of the infection. What’s your advice this year as we head into peak week?
Speaker 2 (55:03)
Yeah, so it’s tricky because, again, like we’ve said on other webinars, nebulizers shouldn’t be used that frequently in the school setting, I understand, in clinicians offices and things, that’s a different story. But again, if a child’s asthma is acting up or they’re ill with viral symptoms, they should be staying home regardless. But I would be cautious, especially this time of year, because, again, we know that the vaccination rates are low in pediatric populations, and we know the virus spreads more easily through nebulization. They can be aerosolized. If it must be used, make sure it’s in a well ventilated room. So as long as there’s a window open to the outside, at least there’s a good flow of airflow. But the enclosed spaces, I would be careful, especially during this asthma peak week and even beyond that, because we’re going to start seeing a rise in flu cases, RSV, everything.
Speaker 1 (56:05)
Yeah. Here in Tennessee, we’ve seen a real rush of RSV in the last few weeks. So you’re absolutely right. We are just in the brink of that respiratory viral season. All right, well, Sally, if you can advance the next slide, I want to remind everyone that our next webinar is actually going to be on Monday, September 19, at 10:00 A.m., and it is on Chronic Urticaria. What I wish my patients knew from actually one of the global experts, Dr. Marcus Mar. So please plan to join us. That is Chronic Urticaria case, for those of you who are on the line may not know, is hives. And there are many patients who have chronic hives. So you can register for that webinar on our home page at Allergy & Asthma Network at the bottom of that page to register as well as to view our webinars. Now, please don’t forget to remain online and answer the two or three minute survey for evaluations. And once again, I want to thank you for joining us today. I, as the president and CEO of Allergy and Asthma Network, just want to continue to wish you a good and healthy day as we continue to work together, to breathe better together, and to end the needless death and suffering due to asthma, allergies and related conditions like COVID.
Speaker 1 (57:25)
Thank you, Dr Parikh, and thank you all for joining us today.
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