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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on January 12th, 2022

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COVID-19 Update 1/12: Omicron Cases, Hospitalizations, Testing, and More

COVID-19

On this week's COVID-19 update, Dr. Bishop provides an update on Omicron cases, hospitalizations, testing, monoclonal antibody treatments, and more. Watch the update below or keep reading for a full recap. 

Omicron Cases

First things first, pretty much everywhere cases continue to skyrocket. Yesterday we had 17,000 new cases in Virginia

I think it's probably pretty similar in most other places. I do think that looking at the curves, I think we're about to hit a peak on this and plateau out, which is good. I expect we'll plateau out over the next one to two weeks, and then over the next two to three weeks, you'll start to see the numbers come down.

You are seeing quite a lot of community spread. I think it is pretty much all Omicron at this point. There is some Delta that's still hanging around, and I think that's mostly in the people who are getting on the sicker side of things.

Pretty much everyone with Omicron, and this is my clinical experience, and my colleagues have had similar experiences, pretty much everybody with what we believe is the Omicron variant is having sort of an upper respiratory illness — runny nose, stuffy nose, a mild cough, and a sore throat. It's a little bit different than what we were seeing with Delta and Alpha and the other variants, where those people had really bad fevers, really bad body aches, really deep cough, more like bad flu.

The Omicron really is more like a classical sort of sinus infection, upper respiratory virus, sore throat syndrome for the vast majority of people. Not for everybody, of course. There are always exceptions to these sorts of generalities, but for the most part, most people who are getting sick are mildly or moderately ill at the worst.

We've had very few patients need to go to the hospital or the emergency room from our practices here of late, which is great news. And I think that jives pretty well with what you're seeing across the board. The hospitalization rates for Omicron are pretty low.

From COVID vs. With COVID

We do have lots of people in the hospital right now with COVID, from COVID. That's a whole area of controversy.

It's a little bit tough to figure out, and I know that's been in the news a lot this week, how many people are in the hospital because of the effects of COVID, how many people are in the hospital for other things and they also happen to have COVID at the same time, huge area of controversy right now. We're not going to solve that here today, but just to give a little bit of sort of sympathy to that issue, it's a really hard thing to parse out from a statistical viewpoint.

It's easy enough for the doctors for the most part and the nurses taking care of a patient to say, okay, this person is here. Yes, they have COVID, but they're really here because they have a urinary tract infection or because they have a completely unrelated problem with their diabetes or they broke their leg or whatever. But when you're looking at large datasets for say an entire community or a state or a nation, it gets really tough to figure out, okay, what's going on here?

You really have to dig into the coding data, so I am sympathetic to the fact that there are data problems. I do find it a little concerning that we've been dealing with this for two years and they haven't built any solutions to this data problem, which we know has been an issue from the early onset of things.

I think they should have built a solution by this point, but I am sympathetic to the fact the data can be hard to tease apart. Even though the Virginia Hospital Association's saying we have 3,900 patients in the hospital across the state, that's the number as of today, that have a positive COVID test or pending COVID test, that does not mean that all those people are actively under treatment for COVID and are in the hospital because they have COVID. It's just a little confusing.

To take that number down a little bit further, if you look into the VHHA data, they're saying of that number — 3,900 — 600 are in the ICU and 345 are on a ventilator, so probably we can feel fairly confident the ones on the ventilators are probably there because of COVID.

For the rest of them, it's a little tough to say without knowing a whole lot more information. So, who knows what that means, but what I'm telling you clinically and what we're all seeing out clinically out in the world and my friends, family, everybody I know who has COVID right now, pretty much they're all mildly to moderately ill and very few people have had to go to the emergency room or hospital, which is great news. 

Testing: Get a PCR test to confirm a rapid negative. 

Testing continues to be an issue in terms of accessing tests. I know there was a statement that came out from the federal government yesterday or the day before saying that as of this weekend, you'll be able to get reimbursed from your insurance company for up to a certain number of tests per month for each person.

The problem with that is, of course, that the supply is still really constrained, so there just aren't that many rapid tests available. That's problem number one.

Problem number two is that until they change the rapid tests, the utility of those is somewhat limited because they are having reduced sensitivity to the Omicron variant. If you are sick and you take a rapid test right now and it's positive, you can believe that.

If it is negative, however, you really need to get a PCR test done to confirm it because you cannot believe a negative test if you have COVID symptoms, that's a negative rapid test. You can believe a negative PCR, but you cannot believe a negative rapid test.

It may be a false negative, and you may still have COVID, so please don't rely on a negative rapid test to say I'm good or I'm clear. It doesn't work that way right now. You still need to get a PCR test done in order to confirm that you do not have COVID.

I know that those are hard to come by, and I know that's become a struggle and the lines are long, but please just don't rely on a negative rapid test to think that everything is fine because you may still have the virus. So best bets, if you're a PartnerMD patient, just call us up. We will be able to take care of that.

If you are not a PartnerMD patient, BetterMed, Patient First. There are a few other testing centers around town. Some places are charging out of pocket and you can get reimbursed from your insurance company.

But the best bet is to get a PCR scheduled if you want to be sure. It may take a day or two to get the results back, so you do need to stay isolated while you're waiting for those results to come back.

Monoclonal Antibody Treatment Update

Let's pivot a little bit to treatments. Because there is still some Delta variants around, and particularly the Delta variant seems to be more prominent in the people who are sicker, thankfully the U.S. Department of Health and Human Services changed their minds, and they are now going to continue to let us use Regeneron and a couple of the other monoclonal antibody treatments that work well for Delta.

They are going to allow those medications to be released again, which is great. I think it was not a good decision to pull those medications off of the shelves and make them unavailable because we still were having a lot of Delta around, and those monoclonals still work just fine for Delta. We should have still been using them because the people who are sicker more than likely are going to have Delta versus Omicron, so we need to continue using these monoclonal antibodies for anybody who is on the sicker side or who is at higher risk for getting worse with COVID at this point.

We do have Sotrovimab, and that is something that the supply is picking up for that, still very low supplies, and then we have Paxlovid, which is the medication, the Pfizer oral medication. That also seems to work fairly well. We've been using it here at PartnerMD with pretty good success so far, and there's a decent supply out in the community. We've been able to locate a fair number of pharmacies that have it here in the area, so that's good news as well.

Hospitals Stressed

Numbers are going to continue to go up for a couple of weeks. Just be prepared for that. Most people who are getting Omicron are not getting very ill, which is great news.

The numbers for hospitalizations are confusing. We don't know what's what. It's going to take some time to parse that out. CDC and VDH really need to get on this and figure this out, because I think it's creating a lot of confusion.

And of course, it's compounding a lot of the hospital staffing shortages because people are burned out and they're tired, and we need to know what's going on. Who's in the hospital with COVID? Who doesn't have COVID? Who's in the hospital because they have something else going on and they just happen to have COVID?

It's creating a lot of confusion and a lot of angst amongst hospital staff, and I think that's contributing to burnout. It's contributing to staffing shortages. Not to mention a lot of folks just in general have COVID right now, too, and so they are either not feeling super great or they can't be at work right now for that reason or another. A lot going on and the next few weeks are going to be a little challenging.

Our governor here in Virginia did issue a limited emergency declaration this week to provide some additional resources to the hospitals, which I think was a good thing to do. That will help, because clearly, whether they're there for COVID or not, it doesn't matter.

The hospitals are clearly very full at this point and they do need some more help, and I'm glad that we are going to be at least providing some more resources. It's going to be like this for a few weeks, and then hopefully things will start to taper down as the Omicron wave subsides.

This is my plug yet again —if you have not been vaccinated at this point, please go ahead and do so.

The pace with which this is kind of ripping through the community, this Omicron variant, is amazing, to put it mildly. And I think a lot of the reason that people are doing very well with Omicron — I think it probably is a little bit of a milder illness — but people are vaccinated.

Most of the patients that I have seen that are doing very well with very minor symptoms are vaccinated. It's the unvaccinated people who continue to do very poorly for the most part, whether it's Delta or Omicron, so please get vaccinated if you haven't done that and you are high risk, meaning you have any medical problem and/or you are 50 or older.

If you're 75 and older, strongly consider getting a booster shot, a booster dose of your vaccine of choice at this point. If you haven't done that yet, go ahead and please do that sometime soon. Hopefully, things will start to calm down here over the next couple of weeks.

Enlarged Lymph Nodes from Vaccine

"Have you been aware of folks who experienced prolonged enlarged lymph nodes from the vaccine?"

Yes, that can happen. This may be especially relevant for women who are thinking about or will need to get a mammogram in the near future. We've been talking about this since last year, but just as a reminder, you can have actually enlarged lymph nodes after vaccination for four or six weeks.

If you are a woman and you recently got vaccinated, it is recommended you wait at least six weeks and maybe up to eight weeks in some cases before you get your mammogram, because it can cause abnormal lymph nodes on that side of the body. You don't want that to be picked up as an abnormal mammogram. So yes, absolutely, you can have enlarged lymph nodes for a good while after vaccination.

When is the next update? 

The next update will be on Wednesday, January 19 at 1:00 pm on our Facebook page. For those without Facebook, we will post our written recap on Thursday.