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Ep. 168 - LiveWell Talk On...COVID-19 (January 14, 2022)

episode 168

Ep. 168 - LiveWell Talk On...COVID-19

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Dr. Arnold:
This is LiveWell Talk On…COVID-19. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. In today's podcast. I'm gonna give an update on the status of the Omicron as well as testing and what we're seeing in the hospital and drift slightly into the monoclonal antibody shortage and how we're addressing that. Also at the end, I'll get into another issue or another session of our mailbag, and we'll answer some outstanding questions from our very intelligent listeners. What we're seeing in the hospital. And I think this is a good sign. We're seeing hospitalizations stay steady with cases in the county going up. And so what that tells me is that the Omicron variant is causing illness, but not hospitalization. And we have about two or three weeks as data that show a trajectory of the cases going up, but the hospitalization staying flat, if not actually decreased a little bit.

And I think that's a very good sign that Omicron may be nature's natural vaccine giving a mild illness that conveys some degree of natural immunity. Now in the mailbag session, we'll talk a little bit more about natural immunity but I think Omicron provides a glimmer of hope that this pandemic may be transitioning to endemic at some juncture in the near future and by near future, I mean, in the next six months. Now, what's the bad, what's the downside of that is those cases going up, we have a lot of staff that is out ill. You know, I think it was 156 today or yesterday that and mercy has a proportionally, a number similar they have a smaller staff than we do, but that, that, that puts a lot of strain on a department.

I mean, you have a critical care department with X number of nurses and three or four of 'em, five of 'em are out sick. That puts a really significant strain on that service line. And that is being felt by our staff and we're doing our best. I do wanna give a podcast shout out or gratefulness message of gratitude to Linn County Anesthesia, our anesthesiologists that serve the community. They have really stepped up and helped out with the respiratory therapy, and I'm very thankful for that. And so are our team members. Now Omicron. So as of December 18th, 2021, so right at a month ago, there was no Omicron in the water supply here in Cedar Rapids, water, municipal water supply. The excuse me, the wastewater there was none detected. Now, December 31st, Linn County Public Health reported that 20% of the virus in the community was Omicron the rest of it, Delta.

This week, it's 100% Omicron . So it is climbed, not necessarily exponentially, but significantly fast in the community. And as I stated before, I think the Omicron is providing a degree of illness without hospitalization, which is good. We stayed busy at the hospital, and this goes back to I've said this before that we suspended healthcare for six months in 2020 into 2021. And that tsunami of illness is playing catch-up, or is coming into a presentation from diabetes and heart disease, that wasn't treated. That with the additional surgical procedures that were delayed, that need to be caught up. And then on top of that, you find these breakthrough cases in the Omicron variant. If I could go back in time and was king for a day I would have given - and I would have known that the vaccines were gonna wear off - I would've probably delayed vaccination until the fall and that would've got us through the winter and we'd be in a different scenario.

So what we've had is really the vaccines dropping off in efficacy at the time that your winter census is going up with other cough, colds and other flu-like conditions. Speaking of flu or influenza - influenza is in the community 58 cases the week before and 64 to date with only all of Influenza A, and one of them is in influenza B. The RSV respiratory virus is relatively low compared to past years. And no hospitalizations for influenza. As of this podcast that I'm aware of now, Pfizer recently came out with a news release or a tweet, if you will, that they would be working on an Omicron vaccine or an Omicron booster that would cover the vaccine. Now I'm not so sure that's going to be of need, because I think it might go through the community so fast by the time they got it to market, we've all had it. Seen a lot of breakthrough cases, see in patients that had fully vaccinated boosted, and still getting the Omicron

But I do want to correct one thing. You see this in some of the press and some of the talking heads on depending what news station you're watching or listening to on talk radio, they'll say that being vaccinated makes you more susceptible to Omicron. That's not true. Being vaccinated, you're protect from Delta. Therefore, if you have a breakthrough, it's probably gonna be Omicron. So that's not a fair comparison. And vaccination still prevents death. It prevents funerals, or it curtails the number of funerals that are gonna take place. And I still strongly support the vaccination with the booster, if you can. My, as some of you know, I've spoken in the past, I have a daughter that plays college basketball and NCAA is actually changing their definition of fully vaccinated to if you don't have the booster: it's J and J you're fully vaccinated for two months, Pfizer, five months Moderna, six months.

And I think I read also they shortened the duration on the Moderna booster. So booster, I, if you're boosted, then you're completed vaccinated. So that is a change so that we'll have some testing and we'll have to get to Elizabeth a booster. I wanna talk about the monoclonal antibodies. Monoclonal antibodies, I've been touting on podcast and interviews and to my colleagues for quite some time. They are an antibody that protects someone that has COVID from being placed in the hospital. And we were having a very busy, but efficient and successful service line of administering these antibodies and the old internist PC building here in Cedar Rapids and things were going quite well. But then the Omicron variant, which is resistant to the combination of antibody we were using, for example, the Regeneron it, it prevented us from ongoing use of the Regeneron.

And so we had to switch to Sotrovimab. that is monoclonal antibody and unfortunately, or, pragmatically or practically, I guess the best description is we had six doses. That's six. With over 150 orders. We're using the National Institute of Health tiering criteria, tier one and two are eligible. And it essentially directs us to giving the unvaccinated and who are at the most risk of hospitalization and the those with high-risk medical conditions, including, but not limited to over the age of 65. There is a new monoclonal antibody coming on the market Evusheld, E V U S H E L D. I hope I'm pronouncing that correctly. But that can be given intramuscular a shot as prophylaxis for those who have not had an adequate immune response to the the vaccines for example, people on active chemotherapy, and we have arranged for some of that patients on solid organ transplant.

Those, those are candidates, and we're gonna be making arrangements for them to get that. Actually, I think some have received it today. Other things in the news, I think that are kind of interesting is one is the CDC now notes that cloth mask aren't effective, which we've been saying that for awhile. And also that patients are in the hospital with COVID, but not necessarily because of COVID. Now I interpreted that sta a little different in saying that if you have multiple medical conditions, you get COVID. COVID, you may have succumbed to those chronic medical conditions, but COVID, didn't allow you to survive the illness. Those, those medical conditions didn't allow you to survive COVID. So, it is, it is related. And I think I wouldn't piece that apart too much other than some of the pediatric hospitalizations, but from a data gathering standpoint it's really well, all we really had at one juncture was just the results of testing.

So you could have a car wreck be admitted for whatever trauma you sustain, test positive for COVID perhaps asymptomatic and be counted as COVID admission. And, I can understand why people say, well, this exaggerates the total numbers. Yes, I agree. But also remember that from a resource standpoint, our staff was even if you're that trauma car wreck emitted with COVID, we're using the mask, we're using the gowns and we're using the N 95. We're using the PAPRs, if you don't have an N95 that can fit. So we're taking all those precautions and that does consume resources and time for our staff. So it is worthwhile out to monitor for those, and then the going healthcare providers going from 10 days to five days. That's not quite as simple as it sounds but, that has been put in effect and the hospital leadership is working to get people back, back in the, back in the trenches as one might say. That's the end of the COVID 19 an update for today, stick around and we will be right back with the mailbag.

Welcome back to the mail bag. The mailbag is a segment of the podcast where I answer questions that are submitted by our outstanding listeners. And the first one is from Alexa. "When do you think masking will go away? And is there a certain metric we need to reach?" The CDC issued indoor masking recommendations when a community is in high transmission. And if we can get down to moderate transmission for 10 days then that is a time when we can stop masking. Moderate transmission would be 10 to 50 cases, per hundred thousand and a positivity rate of 5 to 7.9% . Right now our testing at St. Luke's has a positivity rate this morning of roughly 42%. And I believe we're in around the 800 mark of cases per hundred thousand. So we actually have a long ways to go until we're back into the moderate phase.

I would plan on wearing an isolation mask if wear it appropriately. Don't touch it, use it once, as we've said before. And I would plan on doing that at least until March 1, at this time, hopefully we'll follow those metrics and, we can curtail them when we've reached that moderate transmission range. And those numbers are for Linn county. The next question is from Cam, "Will booster shots become a yearly thing?" Maybe. If there's a natural reservoir for COVID, SARS 2, then we may end up with a phenomenon similar to influenza. It's difficult to compare COVID to influenza, because they're two different viruses and I think it's wrong to take our experience with influenza and think that it's gonna actually match with COVID. So it's hard to say, but if it indeed did come from a lab leak in Wuhan, then that means, might mean there's no natural reservoir.

And so this, this may just become - pandemic fades away and we don't have to deal with it. If it does endemic, we may have to have booster shots. But if we do have booster shots, it's gonna be for the high risk, those over the age of 65, it will be we'll have enough resources and we'll have enough experience with it that we will be more strategic and target those that are at the highest risk. Similar to what we do with influenza act. The next question is from Karina, "Do we know how long natural immunity lasts once it wanes? Do you still have amount of immunity or are you theoretically at the same risk you were previously to your first COVID infection?" This is a great question, and you notice lecturers always say, or professors in college ,They say, 'it's a great question' when they are not too sure about the answer.

And so this is a great question because I'm not too sure about the answer or I don't have a definitive answer. Natural immunity with COVID, we know, can last up to a year. And that's because with the Cleveland Clinic's data, that, that last up until that time. The concern with respiratory viruses is that they change become variants, and so you might not have as much immunity to the next variant. That's why we get the common cold over and over again, because it, it changes ever so slightly. Natural immunity, however, getting the infection and then having natural immunity. I think that is superior over the virus, excuse me, over the vaccine. For this reason, the vaccine is creating antibodies, just to the spike protein. Having the infection, you have antibodies, the spike protein, the M protein, the capsular antigen, you have more cellular and humoral antibodies T-cells and B-cells that remember that and do protect you.

And there's always a little overlap protection. So you're never back to the same risk you were from the beginning. Now we've seen, I've seen up until about four weeks ago, I was familiar with maybe two or three cases of people that had COVID 19 and then got a second time within a year. There may have been others. I'm just ones that I'm familiar with. Now it's everybody's has it. And they're boosted and vaccinated, not everybody, but they're vaccinated and boosted and they're still getting the breakthrough. And that reflects the transmission of Omicron. Fortunately, as we said in the, I guess, update today that that does pretend or foreshadow that perhaps this may be ending - the end of the pandemic as the Omicron causes illness, but yet not hospitalization. And we can only hope. That's all for the mailbag today.

If you'd like to submit to question the mailbag, go to unitypoint.org/mailbag. I'll answer questions about COVID 19, the latest technologies what's going on in the hospital, follow up to old podcast (if I said something that you want clarification) please don't hesitate to do that. And I'm always willing to take questions about UnityPoint Health and the service lines here in Cedar Rapids and how proud I am of my colleagues with their innovation. They never cease to amaze me. Please note, however, the mailbag is not an alternative to medical care. If you have a medical condition please address that with your primary care provider. If it is an urgent concern, an urgent care and an emergent concern, always dial 9 1 1, or go to, to the nearest emergency room. Once again, you can submit your questions to me at unitypoint.org/mailbag. That's common spelling of mailbag, M A I L B A G. I look forward to hearing from you, our amazing listeners.

Thank you for listening. COVID-19 update for latest on COVID-19 vaccine information, more visit unitypoint.org. Thank you for listening. LiveWell Talk On... If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple podcast, Spotify, Pandora, or wherever you get your podcast until next time be well.