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COVID-19 Update 3/16: Evusheld, 4th Boosters, and Case Numbers

March 17th, 2022 | 5 min. read

By Steve E. Bishop, M.D.

On this COVID-19 update, Dr. Bishop talks about Evusheld, getting a fourth booster shot, and updates on dropping case numbers. 

NOTE: We're going to do these every other week for a little while, just because the COVID news has slowed down, which I think is a really good thing and bodes well for us.

Treatments: Evusheld

So biggest, most important update, the only real quote of big news that's come out in the last couple of weeks in terms of COVID either treatments or vaccines or whatever is the FDA updated their recommended dosing on the product Evusheld.

So Evusheld is that pre-exposure prophylaxis monoclonal antibody, so it's an injection that can get if you're high risk for a bad COVID outcome and have an abnormal immune system. And so you would take this as a basically a pre-treatment before you get exposed. You can do this in addition to vaccination, and it gives you about six months of protection from COVID.

It gives you the antibodies immediately, rather than relying on the vaccine alone to give you the antibody response from the body. If your immune system isn't normal, you may not respond well to the vaccine, so this treatment just gives you the antibodies directly.

They're long-lasting. They stay in your system at least six months, and so you would get this treatment about every six months.

Now, the FDA updated their dosing guidelines for this and basically doubled the initial dose. So, it did some follow-up testing and said, oh, you know, it looks like that one, that 300 milligram dose we were giving, it's two different antibodies, each are 150, it's a little bit of a nuance. But this 300 milligram dose of total antibodies you're getting isn't really maybe enough to cover omicron, so let's do 600 instead for that initial dose to get the antibodies levels up faster. So anybody who's already gotten a dose of Evusheld, you should actually, they're recommending to get a second dose now of 300 more milligrams to get a total initial dose of 600, and then you would follow up I believe with a 300 milligram dose every six months after that. But that initial dose needs to be 600 milligrams.

So if you've gotten Evusheld or you know someone who's done that, tell them to call their doctor and say, hey, I heard about the FDA's updated guidance. I heard I need a second dose in order to get up to that 600 milligram initial dose level. I started contacting some of my patients who had this done so we can get them in for a second dose of that. But after that, hopefully things should stabilize with that medication, and it'll just be once every six months for those who need it.

It's a great pre-treatment, a great thing to do for people who, again, you're on chronic immune-suppressing medicines for a whole host of reasons, right? Maybe you have an inflammatory bowel disease or rheumatoid arthritis or something like that, or maybe you're under treatment for cancer. You're on chemotherapy right now or just finished chemotherapy recently. Anything like that, or you have a genetic immune system issue. Any kind of situation like that, you're a great candidate for this. I would ask your doctor about it if you haven't already.

If you'll be getting it new, fresh, and starting it soon, you'll get the 600 milligram dose from now on, so you won't need to worry about coming back soon for a follow up dose. You just do the once every six months. They'll be giving out the 600 milligram dose from the start now, since that's the new guidance. So that's the big update for this week. We're still waiting to hear more.

Fourth Does of Vaccines

I know a lot of people are asking questions about fourth doses of vaccine. We talked about this a little bit in prior weeks. Unless you have an abnormal immune system, there is no indication for a fourth dose of vaccine right now. You should wait and hold off. You've got your two primaries and your booster, a third dose if you want to do that. There's no indication yet for a fourth dose for people with normal immune systems, so not yet. So keep waiting for that. More to come I'm sure in the coming months.

Update on Case Numbers

And then the big update on case numbers, I mean, essentially everywhere cases have collapsed by probably 90 percent-plus. I know that's the case here in Virginia and pretty much all over the country, as well, where cases have collapsed down, which is great. So the omicron wave is well and pretty much truly over.

It doesn't mean that we aren't still having cases. We are still having about 1,000 cases a day. We are still having about a 1,000 fatalities a day in the United States, not in Virginia. That is coming down. It is coming down. That is dropping, yet we were still running, you know, 2,000 seven-day average a day over the last couple of weeks, but that is coming down. So it is starting to come down and I think you're just seeing the lag time from when the cases finished dropping off.

But again, that's just to say that COVID isn't gone. It's not going anywhere. It will ebb and flow. We will probably have spikes again in the future. I know we're in a lull right now, which is great. And again, that's a good time if you haven't gotten vaccinated yet, it's a great time to do it. We're in a lull. Go ahead and get it done soon.

But along with this lull, we're seeing lots of rollback of mask mandates, of travel restrictions, travel testing requirements. So this is all great news and I hope these things will continue to be rolled back as we continue to sort of integrate dealing with the virus into our sort of normal routines and accept the sort of endemicity of it. Again, and it's going to take a little time, and that's okay. But again, these lulls are nice times to take advantage of getting vaccinated if you haven't yet. Most people have who want to at this point. Most people have done that.

You know, I think in Virginia, I'm going to pull up the latest about, you know, a significant percentage of our population has been vaccinated, in terms of the adult population, has been vaccinated at this point. So we've got about six million people in Virginia who've been vaccinated at this point out of a population of about eight million. So that's pretty good. You know, higher would be better, of course.

It looks like Stephanie got the number there, the official number there is at 72%. So if we could get that up to 80%, 85%, I think that would be better certainly, but I think we've done pretty well overall with that. So, but again, the lulls are a nice time to get that done when the cases aren't raging out there.

Second booster or not?

Deborah says, we got a question here. "I came on site late, but I'm confused by what I heard. "Second booster or not? My doctor tells me I have the highest number of antibodies I could have, and that a booster isn't recommended at this time. Is this still the recommendation?"

That is correct. That is correct. So what we were talking about, Deborah, if you came late, we were talking about Evusheld, which is that pre-exposure prophylaxis monoclonal antibody. Those people need to get an extra dose of that who've already gotten it. They need to get an extra dose of that to get they're level up to 600 milligrams for an initial dose.

The booster shots, no. If you've had three shots already and your immune system is normal, there's no indication for a fourth dose at this time. So no need to get that done if you've already had three, had three vaccines and your immune system is otherwise normal.

Glad that's hopefully helped clarify things there. Okay, everybody. Everybody have a great week. Enjoy the nice weather. I hope it's nice where you are, and we will see you in two weeks. Take care.

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.