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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on September 21st, 2022

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COVID-19 Update 9/21: Flu, Boosters, Evusheld, Nasal Vaccines, and More

COVID-19 | Facebook Live Recap

On this month's COVID-19 update, Dr. Bishop discussed flu shots, COVID boosters, Evusheld, nasal vaccines, treatment options, and more. Watch the video below or read on for the full recap. 

Flu Season

 First of all let's talk a little bit about — it's that season, it's the Fall in a couple of days, so it's time to get your flu shot.

Anytime between now and mid-to-late October is a great time you get your flu shot. Go ahead and do that. You can get them at pretty much any local pharmacy. We'll have them in stock at the PartnerMD offices for our members, probably in a couple of weeks. So sometime in October, if you want to come here and get those done, we can do them here for you.

COVID Boosters

After that...COVID boosters. You can get them at the same time as the flu shot, or you can space them out. It's very much up to you. If you want to get them on the same day, that's totally fine. That's a completely safe thing to do.

And in terms of COVID boosters, if you are definitely in a high-risk category, if you are 65 and above, if you have lots of chronic medical problems, now may be a good time to go ahead and think about getting the booster.

They have the new bivalent boosters for the Omicron strain. If you have questions about whether you're a good candidate for the booster or not, that's something you definitely want to ask your doctor about.

Things have become very nuanced at this point in the pandemic between all the developments with the booster doses and the changes in the virus, and with so many people who have already had COVID.

You may be asking yourself, "I'm not sure what to do." And that's okay. It's perfectly natural to be confused about what to do because there are so many variations at this point.

So go ahead and reach out to your doc and ask them, "Hey should I be thinking about this booster now? Should I wait? If I had COVID recently do I need to wait longer to get the booster shot?"

All those are questions and it's so nuanced and so individualized. Reach out to your doc and ask them what you should be doing about a booster.

We would recommend, in general, that most adults get a flu shot though. Do go ahead and do that one way or another. And if you want to do it the same day as your COVID booster, if you're getting that as well, it is totally fine to do them at the same time. 

Evusheld

The other thing you may want to think about is if you are a high-risk person — meaning that you've got lots of chronic medical problems, and especially if you're on any medicines that suppress your immune system for any reason — you may want to ask your doctor about getting a dose of Evusheld.

That's the preexposure prophylaxis antibody treatment. It's two injections, and it protects you for about six months. Very good protection in terms of reducing your risk of contracting COVID, and you would do that potentially in addition to getting a booster shot.

But it is something worth asking your doctor about. We have access to it here in the Richmond area and most places have access to it now at facilities in their region.

Nasal Vaccines

So what's come out here lately is that China and India — and Iran and I believe Russia actually as well — have recently approved the release of nasal vaccines. Here is an article out of nature.

If you want to read all about them, we've been talking about it on this Facebook Live for quite a while, about the need for intranasal vaccines because intranasal vaccines do a better job of producing what's called sterilizing immunity.

We've talked about it using different words, but it's immunity that has a very good chance of actually preventing spread, preventing transmission, and reducing overall infection — not just reducing hospitalization and fatalities like the injection vaccines can do — but actually stopping the spread in a much more efficient way.

When the antigens from the virus are delivered to the mucosal service, it actually does a better job of stimulating the immune system to say, "Hey this is where I'm encountering this virus. This is where I really need most of my antibodies to be developed on these mucosal services."

And it develops the production of a different type of antibody, it's an IgA antibody, which is a mucosal surface antibody.

It's actually a little different than the IgG that's circulating around in your bloodstream. The nasal vaccines are probably going to do a better job of that. We haven't seen large-scale trials in the U.S. yet of these, but eventually, I think it will come here, and we will see these over the next couple of years, especially as the virus continues to circulate.

COVID Treatments

We had a question pop on the blog about COVID treatments. What are the latest updates in COVID treatments and specifically whether you should seek treatment with some sort of off-label medications?

A couple of things about COVID treatment. First of all, if you get COVID and you've been vaccinated, you've been boosted — and you're not feeling bad, you're not very sick — and you're relatively young and healthy, you may not need to get any specific treatment for COVID.

This is another thing where if you get COVID and you're feeling bad, definitely call your physician, and ask them what you should do.

You may opt to do nothing and just hydrate and rest and treat it like a cold or any other common viral illness. Just wait it out. And that may be perfectly the appropriate thing to do. That's what I did for myself. That's what many other people do when they get COVID, especially if they're on the younger side and they're generally healthy. They can just wait it out, and they're probably going to do just fine.

The other option that's FDA approved — there are two other options — is going to be the medication Paxlovid. That's the pill you take for five days, and that will reduce the intensity of the illness. It is generally recommended for people 65 and up and or those that have lots of chronic medical issues.

There are some side effects to that medication, some nausea, some odd taste, things like that. There is a little bit of a risk for what's called rebound COVID, where COVID symptoms can return a few days after finishing the course of antibiotics. But the drugs do work. They do reduce hospitalization. They do reduce mortality to a degree.

So a perfectly fine option is to seek that out as well, especially if you're in the high-risk category.

The other one is at one of the monoclonal antibody treatment infusions. There are still those available for COVID for high-risk people who either don't want to or can't take the Paxlovid medication for whatever reason.

So there are really three generally accepted options:

  1. Sort of watch and wait. Treat conservatively.
  2. Paxlovid.
  3. Monoclonal antibodies.

I know there's been a lot of hubbub in the media and on Twitter and social media over the last few years about things like Aflumycin, hydroxychloroquine, and other things. The studies continue to be very conflicting. And I don't think that the data is really there to provide any blanket recommendation that people pursue those as a line of treatment.

I think, in general, most people are going to be just as well served by either doing nothing and just waiting for the illness to pass at this point, especially if they've been vaccinated or choosing one of the other FDA-approved options.

Everything comes with risks and benefits, right? So I would say stick with those things. If you have more specific questions than that, that's again another place to have a very nuanced conversation with your physician about how to treat your illness.

There are also plenty of vitamins and supplement things you can do to help boost immunity, and boost your response to a viral illness. Vitamin D, vitamin C, zinc, and things like that that are perfectly well accepted, perfectly safe to do, and fine to use for COVID.

Again, stick with one of the generally accepted options. That's my general advice to everybody. If you have more questions that's something where you want to touch base with your doctor and ask them for more information.