By: Steve E. Bishop, M.D. on May 19th, 2022
COVID-19 Update 5/18: Cases, Paxlovid Relapses, Home Test, and More
In this COVID-19 update, Dr. Bishop provides an update on where we are with cases, hospitalizations, and deaths; discusses the potential for relapses following a course of Paxlovid; recommends a strategy for using home COVID tests; and more. Watch the video below or read on for the full recap.
COVID Data Update
First things first, I want to remind everybody the Virginia Department of Health keeps an excellent dashboard available of COVID-related data. And one of the tabs that they have is hospitalization trends, which is great. That's the one I want to focus on because I think that's really the most important thing right now.
We are seeing an uptick in cases. We've seen it here locally at our offices. Across the state of Virginia, it looks like our positivity rate is up to about 14.8% or so.
And I think we're about to plateau and probably start to be on the other side of this current wave. Remember, we're going to keep having waves, right? This is how these viruses tend to function and COVID has been no different.
We keep having waves over time as the virus ebbs and flows in the community, and we are in the middle of an uptick right now.
Now, this uptick is nowhere near as bad as it was in January and February when we had almost 4,000 people at the hospital at any given time across the state of Virginia.
Right now, we have about 360 people — that's the seven-day moving average of people in the hospital across the state — and there have been very few fatalities overall reported.
Even though hospitalizations have ticked up a little bit and cases have come up a bit, most people by and large are having a very mild illness. We've got about six people in the past week in Virginia or two who have died from COVID, and that trend continues to show a downward shift.
I think that's continuing to reflect the overall mild state of the illness in general. So, again, we're going to have this wave. It's going to come. It's going to come down again.
The vast majority of people are having a mild illness, which is great news, so that is good to know.
Paxlovid Update: Relapses
Now, for those who meet the criteria, we have been using Paxlovid a lot more frequently here at our practices. I think it's being used a lot more frequently out in the community, as well, for the treatment of COVID, particularly in those who are over the age of 65 and who are at high risk of progression to a more severe disease.
We've had good results with Paxlovid. Fairly consistent with the data that's from Pfizer.
One question that has popped up in the last few weeks, as we've been using it and had more experience with it, is that there are a certain number of people that do seem to relapse.
They take the five-day course of Paxlovid. They're feeling better. And then after the five days are done, they start to get sick again.
Our take on that — there's been no official guidance out from the FDA on what to do, Pfizer has made a few statements — but most of what the physicians in the community are doing is either just waiting it out and letting the rest of the virus take its course — because again, most people are doing fairly well with the Omicron variant — but if patients are unwell or are more worried that they're going to get sicker again, then a second course of Paxlovid.
A second five-day course of Paxlovid seems to be an appropriate thing to do. And that's what we have mostly been doing at our practices. That seems to be a very safe and effective thing to do for most patients and that tends to take care of the relapsed symptoms.
Some people just are having the live virus in their system longer than others, and they need longer courses. That's okay. That's not uncommon with all types of viral illnesses and bacterial illnesses. Some people just need longer courses of treatment. This is not any different than that.
It's a great drug. I think it's been very useful to us and we will keep using it in those patients that we think are high risk.
COVID Testing at Home
So the last thing I wanted to touch on is this question about home tests. I know since we've had Omicron show up, a lot of people, including myself, have been worried about the home tests.
They just don't work as well with the Omicron variant. They're not as sensitive, meaning you can still have Omicron and your tests can come back negative, even though you do have the illness.
Scientists have been trying to figure out what to do about this problem. I had hoped that they would revamp the tests and just change them. But it turns out that that hasn't really happened just yet.
So the question is then what do we do with the home tests?
You can still use them. If they're positive, you can trust them. If they are negative and you have symptoms that could be consistent with COVID, you probably can't trust a single test.
There have been some modeling studies done using multiple home tests over a course of several days. And it does increase the sensitivity, or the accuracy, of the tests.
If you do a test, every, say, 48 hours for a few days, you can do a better job of detecting the virus than just using one test one time.
So if you think you may have COVID, and you're concerned and you really want to know for sure, the best things to do are:
- Go get a PCR test, which you can usually do at your doctor's office.
- Take a couple of home tests about 36 to 48 hours apart.
Take one test, if it's negative, wait a day or two, and take another test. And if it turns positive after that second one, then you can trust that positive result. You can trust it if it turns positive the first time too but if it's negative and you still have symptoms, you already may have COVID, I wouldn't trust that test.
Either take a second home test a couple of days later or find a PCR test at your doctor's office as well.
If you are running low on home tests, I think supplies are better. You can order a new set of home tests from the U.S. government through the postal service. If you want to get more home tests, you can do it that way too.
We posted links on our Facebook page, I believe yesterday or the day before.
(Editor's Note: Here is the link to the ordering form on the USPS website. Each household can order a round of eight tests.)
So those are the big updates for this session. Again, a little bit of an uptick in COVID cases, hospitalizations overall remain low, and fatalities remain low, which is great.
Paxlovid continues to be a safe and effective drug in the treatment of COVID in high-risk people. And some people do relapse after five days and need a second five-day course and that's okay and appears to be safe to do.
Again, that's not a recommendation from the FDA, but that's what a lot of physicians and people at Pfizer have been talking about. It seems to make good clinical sense and appears to be safe to do.
And then, home tests. Don't trust a single negative test. You need multiple negative tests to confirm more or less that you don't have COVID. Most accurate testing continues to be getting a PCR done.
Deaths in Vaccinated vs. Unvaccinated
"Are the deaths all in people who have not been vaccinated?"
That's a great question. VDH changed the way that they're reporting some data. I did find the data, and the dashboard on the deaths by vaccination status is still on the health department website.
The fatality across the board is pretty low, so it's a little bit hard to tell. It looks like they've got rates of death per hundred thousand from January to now.
- For vaccinated people, the rate of death is 39 per hundred thousand.
- For unvaccinated people, it's 101 per hundred thousand.
Essentially, you're looking at a more than 50% reduction in the death risk just from those raw numbers real quick there.
And they're reporting, even for unvaccinated people, the fatality rate is 0.25 per hundred thousand right now, and for fully vaccinated people it's 0.02.
You're seeing a significant reduction in the death rate with vaccination, but the fatal rates are low overall, which is great.
(Editor's Note: The VDH retired the referenced dashboards on May 19, 2022. They now recommend using the data provided on the CDC's COVID data tracker here.
Pandemic or Endemic?
"To your mind, are we still in a pandemic emergency or is COVID now merely endemic? Are we somewhere in between?"
I think we are definitely in the endemic phase. I think that the virus is not going anywhere ever perhaps and certainly not for a long, long time. I think we're going to continue to see waves of it over time and yeah, it's essentially become endemic to the population.
I know there are different people that have highly specific technical definitions for pandemic versus endemic, but I think for all practical purposes for those of us on the ground, sort of on the front lines, doing the patient care, et cetera, I think most people are in the camp that, hey, this is an endemic illness now. It's not really going anywhere.
It's like the flu in that regard. It's going to come seasonally or on a certain frequency. We're never going to eradicate the flu, and I think most of us have come to the same conclusion about COVID. It's not eradicable per se.
When is the next update?
We will see you the next time we do this, which will be next month. It's going to be on June 22 at one o'clock. I hope everybody has a great week this week and a happy and safe Memorial Day.