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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on December 29th, 2021

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COVID-19 Update 12/29: Omicron, CDC Guidelines, Antibodies, and More

COVID-19 | Facebook Live Recap

In this week's COVID-19 update, Dr. Bishop discusses the current surge of COVID-19 infections, the new CDC guidelines on isolating, monoclonal antibodies, boosters, and more. Watch the update below or read on for the full recap. 

A COVID Surge

COVID is suddenly everywhere, in all of our practice locations, including here in the Richmond area. Lots of people have COVID. The numbers are way up. The Virginia Department of Health has gone to weekly reporting instead of daily reporting on their dashboard, so I can't see the daily numbers for Virginia at this point.

But starting last week, the numbers started to go up pretty dramatically. I suspect that we will see more of the same this week and for the next several weeks. It may or may not be an Omicron wave, I'm not sure. It's the next question. Is it Omicron? It's unclear.

The Virginia Department of Health does have a dashboard now where they track the variants and they last updated it just after Christmas, on the 27th. And they weren't really reporting very much Omicron in their listing there. And they're still mostly reporting Delta.

I suspect it is somewhat Omicron and there's a little bit of a lag, but I suspect it's still a lot of Delta that's just circulating again.

There's a seasonality to these things. It's the wintertime and we're going to start to see more circulation again, of COVID, whether it's Delta, Omicron, or whatever other variants. There are a few other variants around that VDH is tracking. We still have the Alpha variant, so it's not all 100% Delta, even, even though most of it is.

If you want to track that, it's updated about once a week as well. You can see that data there and they'll start reporting Omicron whenever it is seen. It's important to track that for a couple of reasons.

The most important being that we don't think that Regeneron is going to work well for the Omicron variants. That's one of the monoclonal antibody treatments. But the Sotrovimab works fine. We are waiting for supplies of that new monoclonal, Sotrovimab, to pick up.

It's good that we don't have a huge Omicron wave in Virginia just yet so we can keep using our other monoclonal antibody treatments while we wait for the Sotrovimab to become available.

But all in all, I can tell you that the case numbers in Virginia, in this area at least, are way up. We have been at maximum testing capacity and above testing capacity every day this week here at PartnerMD and across PartnerMD offices with a large number of positive patients.

Get Vaccinated and/or Boosted. 

So COVID is back with a vengeance. Please be careful out there. Get vaccinated if you're not, okay? I know that people who have the vaccine are still getting the virus, but by and large, what we are seeing is that the vaccinated have very mild illnesses.

Whether this is Delta or if it's Omicron now, the illness is very mild. They're having a cold, maybe a little body aches, a little low-grade fever. We are not seeing the severe illnesses that we were seeing back in the spring and last winter, by comparison, so that is excellent news.

So please get vaccinated if you haven't already. Please get tested if you have symptoms. I know it is tough to find tests out there. If you can find an at-home test, those are perfectly fine to use.

I know that there's been some worry out there that Omicron doesn't work quite as well, the antigen tests don't work quite as well. But again, it doesn't appear we have a massive Omicron wave here in Virginia just yet.

And the tests do still work fine. They might not be quite as good as with Delta, but you can still rely on them if you get those tests available to you at home. If you can't find one for use at home, call your doctor, try to call one of the urgent care facilities near you, and get scheduled for one if you have symptoms, mostly because if you're in a high-risk category, you should then try to get treatment with monoclonal antibody therapy.

And again, that's another thing. Call your doctor. Ask about it. Ask about it repeatedly and make sure that they send you a referral. There is also a monoclonal antibody treatment locator online, and I'll send that to you guys as well, where you can actually go and look for it yourself, and find a place and you can call them.

Most of these places, you can call them right up and they will help you out. That's by the Department of Health and Human Services. It's combatcovid.hhs.gov/hcp.

Definitely check that out. It says for healthcare providers, and it technically is, but the public can use it too. Use that if your doctor doesn't know where to refer you or doesn't know anything about monoclonal antibody treatment and you are positive for COVID. Those are the big things.

National Case Numbers

If we look at national numbers, case numbers have essentially exploded higher. And I believe we're reporting record numbers, even more than last year. December 28th, it looks like nationally we had 380,000 new cases across the country. That dwarfs what we were seeing this time a year ago where we peaked in early January at maybe 300,000 cases.

We are blowing past that record at this point. But, what's good, if you switch over to look at deaths and hospitalizations. Even though the cases have exploded higher, the hospitalization and the fatality rates have stayed stable. And stable on the lower end of things.

I think that leads credence to the fact of what CDC is saying, what the British public health agencies have been saying, and what the other researchers have been saying — for the most part, Omicron, which is taking hold in most places, seems to be a mild illness. And it's definitely mild for people who've been vaccinated, same thing with Delta.

So even though cases are exploding, the hospitalization and the fatality rates have stayed low, or dropped, and they are stable.

New CDC Isolation Guidelines

This leads us to our next point of discussion, which is that the CDC has changed their isolation and quarantine guidelines and eased them up pretty significantly.

I think a lot of this has to do with the mildness of the illness at this point, especially for people who are vaccinated. For most people at this point, if you catch COVID and you are doing okay with it, and your symptoms are reasonably well controlled, and getting better or gone, you can actually leave isolation after five days.

For unvaccinated people, if you're exposed, then you need to isolate at least for five days and then be tested.

If you are vaccinated and boosted, you do not need to isolate or quarantine after exposure. If you are either unvaccinated or not boosted, then you are technically supposed to isolate yourself for five days and then be tested.

And of course, they're recommending mask-wearing across the board for folks who are exposed or who have illness.

They have cut down those isolation times and simplified things a little bit. And just to reiterate, we've been talking about this because it's been a recommendation from our health department, but CDC has been plainer about it.

Vaccinated = Lower Risk of Acquiring the Virus

"I understand vaccines cause less serious disease, but I don't really understand the impact of vaccines on infection and transmission, so I have a two-part question.

1) If a fully vaccinated person and an unvaccinated person are equally exposed to COVID, will the chance of any infection differ between the two?"

Yes, a vaccinated person will have a lower risk of acquiring the virus. And if they acquire the virus, they'll have a lower chance of having a bad outcome or a severe disease. The unvaccinated person still will have a higher risk of acquiring the virus.

The vaccines are not going to reliably prevent all transmission. They do you reduce it some, of course, and there'll be some effect there, but it's just not nearly as dramatic as we needed it to be to stop the chain of transmission at a large population level.

2) "If both a vaccinated person and an unvaccinated person are infected, do they equally transmit the virus?"

The answer seems to be yes, for the most part, unfortunately.

Back to Normal? 

"Will we ever get to what we used to call normal?"

I think the CDC guideline changes for isolation and quarantine are a step in that direction, and I think, an admission by the CDC that we are not going to control this virus through mitigation measures.

Really, the answer, again, is going to be individual risk reduction through vaccines, through treatment of monoclonal antibodies, and of course, through lifestyle and other factors to reduce your overall risk.

I think this is a step in that direction. I think it's a tacit admission. They're not going to come out and directly say, "yeah, there's no way we're controlling this."

But I think this is a tacit admission that those policies have not worked. And so they are not going to continue to pursue these aggressive isolation and quarantine policies going forward because they don't work. And because they were damaging to the economy and they weren't really helping reduce the spread anyway.

We're seeing massive spread regardless. So I think that's really what you're seeing there. And I think eventually, in another few months, I think you'll see a switch to only get tested if you are symptomatic and isolate only if you're symptomatic. And then things will evolve in that direction. That's my guess.

Antibodies from Breakthrough Infection?

"If you have had all vaccines and have a mild case with very few symptoms, do you still get the antibodies?"

Yes, absolutely. You will. Good question. You will get all the antibodies just as if you had a natural infection because you did have a natural infection. You just didn't get as sick, which is great.

That's why some people are saying maybe Omicron is a bit of a "blessing in disguise" and people who are infected with Omicron naturally, in addition, if they're vaccinated, not only do they avoid severe disease, so it sort of de-fangs the virus with the vaccine, but then you get all the natural portfolio of antibodies and then you have good protection against Delta and the other variants.

Testing for Previous Infection vs. Vaccine Antibodies? 

"I have been vaccinated but I think there's a chance that I could have had COVID two weeks ago because I had mild symptoms. The rapid tests were negative, wondering if it was a false negative. Is there a way to see if I've recently had COVID via antibody testing? Can it distinguish between the vaccine antibodies and actual COVID antibodies?"

Yes, there is a way to do that. Your physician will need to do what's called a nuclear capsid antibody test to check for the non-spike protein antibodies. There is a way to do that. We don't do it routinely but you can request that and that'll give you more information.

Managing Risk for a Family Wedding

"If it weren't my grandson's wedding on January 11th, I wouldn't be going. About 350 people are expected. I'll wear an N95 mask except for the formal photos. But since I have underlying conditions that frighten me if I get sick, especially if a cough is involved, since I have sustained fractures from coughing, I wonder if I should even eat at this wedding. I'd even find a way to eat away from the tables. The wedding is inside, and in spite of the mask mandate, only a couple of us will be wearing masks. What are your thoughts? I'm vaccinated and boosters."

I think you're about as protected as you're going to be with the vaccines and the boosters. And if you wear an N95 mask, I think your risk of getting sick is going to be pretty low, especially if you're maintaining some distance at the event, especially from the largest parts of the crowds.

I think that's about as low as risk as you can get for that situation and sounds like you're on the right track there to minimize your risk but still be able to go to the event.

J&J Vaccine, Moderna Booster

"Do you have any thoughts on how protected a person is after receiving changing J&J and a Moderna booster? It doesn't seem like there's any data out on this with Omicron. I'm ready to get the next booster as soon as I qualify."

Yeah, it's a really good question. There isn't any data on this. My thinking is it's about a number of doses. You're probably just as protected as anybody who's had two doses of anything. I think that that's fine.

Why is Omicron more transmissible? 

"What is causing the Omicron variant to be more transmissible? Is it attached more easily? Is it more airborne? Does it create more of a viral load in folks?"

I think all those things are a little true. The biggest thing is the change in that spike protein. And every time that spike protein changes, it essentially is evolving along with the host. As it changes and mutates, what ends up happening is there's a selection for spike proteins that attach more and more strongly to human cells. So, yes, what is happening is that the virus attaches more readily, more easily. It requires fewer viral particles to create an infection. So yes, primarily it's the changes in the spike protein that are going on there.

Mix-and-Match Boosters

"You probably covered this before. If you've been vaccinated with Pfizer, is it recommended you stick with Pfizer for the booster or get Moderna instead?"

The recommendations out of CDC and FDA are that you can mix and match and do any of the above. Personally, what I've been telling patients, and what I've done for myself, is I tell people just stick with the horse you rode in on.

If you did Pfizer, stick with Pfizer. if you did Moderna, stick with Moderna, just because the data on mixing and matching is very limited.

If you have a specific reason you want to switch vaccine types, from J&J to Moderna or from Moderna to J&J, whatever, then I think that makes sense.

If you didn't have any problem, and you don't have any risk for a side effect from that vaccine type, I say stick with the one you started with. So if you had Moderna, stick with Moderna. Pfizer, stick with Pfizer. Good question.

When is the next update? 

The next update will be on Wednesday, January 5 at 1:00 pm on our Facebook page. For those without Facebook, we will post our written recap on Thursday.