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COVID-19 Update 2/2: Omicron, Vaccines, Variants, Pre-Exposure Treatment, and More

February 2nd, 2022 | 7 min. read

By Steve E. Bishop, M.D.

COVID-19 Update 2/2: Omicron, Vaccines, Variants, Pre-Exposure Treatment, and More

In this week's COVID-19 update, Dr. Bishop discusses the trends of Omicron, why it is important to get vaccinated, additional variants, pre-exposure treatment options, and more. Watch the video below and read on for the full recap. 

Omicron Trends

We're continuing to see the same trends that we've seen in the last couple of weeks. Overall cases are experiencing a significant decline pretty much all over the United States and definitely here in Virginia.

I think our seven-day moving average has almost dropped by not quite half compared to say last week or so. Hospitalizations are down as well, running a little over 2,000 patients in the hospital from COVID-19 in Virginia compared to about 4,000 a couple of weeks back.

As we have discussed, you're going to have the cases drop first, then hospitalizations, and then finally fatalities.

Fatalities have stayed low in Virginia, which is great. Hospitalizations do remain high overall nationwide, roughly similar to this time last year in magnitude.

I think that the thing to keep in mind is there are just a lot more people infected this year compared to last year. So even though the disease is quote "milder," more people are getting exposed. And so a certain percentage of those people are always going to be sicker than others.

That's pretty much going to be mostly unvaccinated people who are dying and who are getting hospitalized. I know there have been lots of breakthrough cases, and I think it's led to this a little bit of a false misnomer or false understanding about the vaccines again.

Effectiveness of Vaccines

I've heard lots of people saying, "Well, I'm not sure what the point is of getting vaccinated. I know plenty of people in the hospital who've been vaccinated. I even know some people who died who were vaccinated. "

And so do I. And that's certainly true. But what I will tell you is that that is true. However, the risk of being in the hospital or dying from COVID after vaccination is markedly lower.

It's not zero. Nothing's perfect. Nothing is zero, but it's markedly lower.

If you actually go on to the Virginia Department of Health website, you can actually look. They do report the cases, hospitalizations, and fatalities by vaccination status.

If you look at infections, you'll see that for every hundred thousand people, the number of cases and/or infections in fully vaccinated people is about 2,200 for basically January.

But for unvaccinated people, it's 10,000. So you're looking at a five- to six-fold risk of infection between vaccinated and unvaccinated people.

If you move to hospitalizations, you see kind of a similar effect essentially. About 60 out of every hundred thousand people hospitalized for COVID were vaccinated, 233 for unvaccinated people.

And then if you look and change the metric to deaths, you'll see 17 deaths for a hundred thousand for fully vaccinated people, but 71 for every hundred thousand for totally unvaccinated people.

You're looking at basically a 400% increase risk of death for unvaccinated people, even with Omicron.

The benefit of vaccination remains, especially for people who are high risks. That means people who have medical problems of any kind. If you fall into one of those categories, I strongly recommend getting vaccinated. Hands down, you should get vaccinated.

The vaccines have been around for a good while now. We have good data on their safety signals.

I understand some people are still hesitant. I get that. But that being said, for adults — especially adults over say 40 or 50 — and any adult with a medical problem, you're going to reduce your risk of fatality by around 400% or so, four times essentially, compared to baseline being unvaccinated.

Now, if you're 22, you're perfectly healthy, meaning you can run a mile in eight minutes, your cholesterol is great, you have no issues. Okay, I can understand. Your risk is super low. Maybe you don't want to get it. I get that.

But if you don't fit in that category and spoiler alert, almost no one fits in that category, you really should consider getting vaccinated if you're an adult and you have a risk factor.

Tracking COVID Variants

Let's talk about variants for a minute. The Virginia Department of Health has a really nice variant dashboard, I've shown it to you guys before, where they track the variants.

This is a question, actually, that my mom was asking me last night again, which is how do we know what variant people have?

The answer is we don't. We don't know actually what variant you have as an individual. The Virginia Department of Health and other big research institutions take samples, look at the samples, and analyze the genetic material of samples.

Then they report the frequency of different variants within those samples. And then we sort of make a broad community-based statement saying, okay, if pretty much all the samples are coming back is Omicron, we know it's Omicron. If all the samples come back as Delta, pretty much everybody has Delta.

They're making an inference there and that's what we're doing here. If you look at the variant dashboard, what they've shown is basically pretty much since December, basically 90% of them since mid-December are all Omicron.

It's still a little bit of Delta out there, especially if you can actually adjust this dashboard to look at hospitalizations and fatalities. Delta continues to account for most of the fatalities that they're seeing in the surveillance data. So a good little piece of information to review and look at.

Pre-Exposure Treatments

Another thing I wanted to talk about, just to bring this back to people's attention, we continue to have issues with the supply of monoclonal antibody treatments.

There aren't that many. And the only one that really works for Omicron is the sotrovimab. That's the only one that's available right now because the authorizations were removed for the others.

But supplies are very low. We're having a harder time getting that for people. If you are a high-risk person, meaning you have an immune system problem, you're on cancer treatment, you are very up there on the age spectrum, or you have any other issue where you think, "Hey, my immune system may not be normal and I'm worried I might not respond well or might not get good protection from a vaccine," then I would actually recommend you talk with your doctor about getting the Evusheld.

I know I've talked about this periodically before, but it's a pre-exposure prophylaxis antibody treatment. It's not meant to treat active COVID infection. It's meant to be given to you before you get exposed if you are a high-risk person.

For example, if you are a patient who is under active treatment for cancer and your immune system is probably not normal, and you may or may not respond well to a vaccine as a normal person would, that's okay. You should get Evusheld. That would be a person to get Evusheld.

You should talk with your physician about getting a referral to get that done because it will significantly reduce your chance of getting COVID in the six months after you get it.

It's two injections, one in each leg, and the rear side. Two injections every six months. But it's long-lasting antibodies, and they do work very well for folks for preventing COVID infections.

Anybody who's at high risk, either can't get vaccinated for some particular reason — you have an allergy, you had a bad reaction, whatever — or you're high-risk and not expected to respond well to vaccination because your immune system is not normal, I would strongly recommend you talk to your doctor about getting Evusheld.

It's available around the community at some of the infusion sites in the Richmond area. So definitely consider getting that if you fit into those categories.

Everybody else, get vaccinated if you haven't already. That's my message, and I'm sticking to it.

Misinformation

"Even with all the time that has passed, I'm still amazed at the misinformation out there."

Yeah, it's kind of interesting all around. I think it's really become very difficult to know who to trust and what information is accurate regardless of source, whether it's from an official source or an unofficial source.

It's become almost impossible to know what the truth is. And so honestly, my best suggestion is to find a physician that you trust and that you know and get medical advice from them that's tailored and personalized for you. Because everything else out there is meant for a general audience and sometimes has an agenda, one way or the other.

So get personal medical advice from someone you trust, and that's probably the best thing to do because also things change over time. And even things that were touted by official channels, they can change over time, and that's okay. Science does evolve, that's fine.

But people don't always get caught up to that in the same way. The official channels don't always catch up fast enough with the new information. So people are left confused. And then, of course, you've got podcasts, and YouTube videos, and all kinds of stuff. And some of that information is actually really good, legitimate information, but it's really hard to know what is what, and what isn't real, and what is real, and what's true, and what's not true.

And it is hard for people who are not medically or scientifically trained to tease out the parts of some things that are probably legitimate and the parts that are not. Because there's usually some mix.

Of course, Joe Rogan has been in the news this past couple of weeks over quote "misinformation." I listened to both of the podcasts that he's being criticized for. I listened to the whole thing and not everything that the guests said was correct. Both of them. Some of them said things that were actually incorrect, factually incorrect.

A lot of what they said was accurate as well. But it's hard to know what's true and what's not. One of the guests, one thing that, in particular, Dr. McCullough said on one of the podcasts, "Oh, you can't get COVID twice." Well, that's not true. I have many patients who have had COVID multiple times. That being said, other things he said were accurate. So it's really hard to tease this out.

And so my best advice is to find a doctor you know and trust. That's why I love working here at PartnerMD and that's why our patients love coming to us because they know us. We know them well. They trust us.

We can have personalized conversations about these things because there is so much just craziness out there in the world that it's hard to know what to trust. So that's my plug for PartnerMD. 

More Variants

"Do you think there'll be more variations like Omicron that are milder?" Probably. Yeah, probably. And in fact, you're already seeing some sub-variants of Omicron pop-up. They seem to be roughly similar, so I suspect we'll keep seeing this over time. It's just the way the virus is going to work, unfortunately.

When is the next update? 

The next update will be on Wednesday, February 9 at 1:00 pm on our Facebook page. For those without Facebook, we will post our written recap on Thursday. 

Steve E. Bishop, M.D.

As a board-certified internist and concierge doctor in Richmond, VA, Dr. Steven Bishop is passionate about helping his patients improve their lives through better health. He helps healthy adults adjust their lifestyles as they age and helps patients with complex medical diseases manage and improve their health.