A message to the readers from Dr. Bill:
The recent CDC guidelines relaxing COVID-19 restrictions mark an important turning point in the pandemic. I expect that within the next few weeks in Central Virginia we will no longer need to mask in indoor public spaces. While this is wonderful news, we do have to be aware that guidelines can change again if a new variant appears, and that we need to be respectful and careful about people who are immunocompromised. But mainly I thought this might be a moment, especially with the two-year mark approaching, to note from whence we’ve come.
It is hard to remember the consternation felt in late February 2020 as the first cases of COVID-19 in the US were recognized at a Life Care nursing home in Kirkland, Washington. The terrible death toll there was quickly followed in March by the cataclysmic pandemic in New York City. It was clear that Charlottesville would not be spared, but it was fortunate that we had warning. Providentially, the South Tower of the UVa Hospital was just nearing completion in February 2020. In it was a new emergency department with greatly expanded space for the isolation and care for those with suspected COVID-19, and beautifully designed space for those ill enough to require hospitalization. The construction team was able to rush the opening of the 5 and 4 South wards for COVID-19 to March, and even to engineer the ventilation of the rooms so that they were “negative pressure,” keeping infectious aerosols of virus from spreading in the hallways. Close on the heels of the South Tower opening was the first diagnostic test in Virginia. That effort was led by Amy Mathers, who despite supply-chain problems, pieced together a PCR test, with research faculty at UVa contributing reagents and PCR machines normally reserved for molecular biology research. Physicians, nurses, respiratory therapists and many others volunteered to care for patients with COVID-19, which pre-vaccine put them at great personal risk. I remember one of the fellow infectious diseases physicians that I was working with telling me how he was reading bedtime stories to his 4-year-old daughter through a closed bedroom door, so as not to potentially expose her if he was to become infected!
And importantly the people of Charlottesville, in part through their participation as subjects in clinical trials, contributed to the scientific advances that have gotten us to this turning point. This included the discoveries that anti-spike monoclonal antibodies prevented, and antiviral agents helped to cure COVID-19. I will never forget patients seriously ill with COVID-19 on 5 South telling me that they wished to participate in a study of a new treatment to “help the next person.” I, and all of us really, owe a profound debt to these selfless individuals, one that we can only pay forward by helping others in need.
As a community we have also contributed to the end of the pandemic as taxpayers though our support of research at universities and the NIH. The pace of discovery is well beyond anything I have seen in my 40 years as a physician and scientist. Vaccines and treatments came about seemingly overnight, but solely because decades of prior biomedical research taught us how to vaccinate against coronaviruses and design antiviral medicines.
So as we transition in the ensuing weeks from the current high transmission levels to a slower pace of new infections that permits unmasking, we are in a much stronger position should COVID-19 return as a pandemic or epidemic. Current vaccines, masks, home diagnostic tests and pills that are freely available are protecting us all. However, not for a moment should we ignore the fact that better treatments and vaccines for children are desperately needed.
I hope that years from now we will look back at this time, and reflect on the contributions of the health care providers and scientists who stepped forward at our time of greatest need.
1. Question: Are we really safe now?
Answer: Great question! I remember Mary Ann and I house hunting years ago and finding something that seemed too good to be true. I asked our realtor if the house was it in a safe neighborhood (this was in Cleveland) and she said “it is right next to a safe neighborhood.” Joking aside, we are much safer than we have ever been. This is not only because of the precipitous decline worldwide in cases of omicron, but because of vaccines that decrease our risk of hospitalization 10-fold, antiviral pills, and widely available diagnostic tests.
2. Question: Why are we loosening everything up but the number of cases is still higher than last August?
Answer: You are correct that in Central Virginia we should not yet be loosening things up, as we are lagging behind most of the country and are still at a high transmission level. I expect that this will change in the next few weeks so that we are at a low enough level to allow unmasking in indoor public spaces. You can look up the rate of new infections for Virginia localities at CDC’s new “COVID-19 Community Levels” transmission site: https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html The CDC site takes into account not only cases of new infection but local hospitalization levels, to better assess levels of serious infection (parenthetically UVa Hospital is down from over 100 to less than 40 patients with COVID-19 this week).
3. Question: I hear about a new sub-variant related to Omicron. Can this turn into a dangerous outbreak?
Answer: The BA-2 sub-variant of Omicron appears to be more transmissible than the original. It is currently about 8% of all COVID-19 in the US (the other 92% is the original omicron variant called BA-1). It is doubling in prevalence each week so may eventually replace BA-1. Its increase however is happening as overall cases of COVID-19 have fallen by 90%, so it does not appear to threaten to cause another pandemic wave.
4. Question: I’m talking to a lot of people who had COVID-19, and they have a variety of odd symptoms still. Is there really something called long COVID-19, and how is it treated?
Answer: Most people completely recover from COVID-19. However in a minority there is clearly a problem with “long COVID-19,” which can include shortness of breath, cough, fatigue, change in smell or taste, joint or muscle pain or fever. Long COVID seems to me to be most likely due to the imbalance of the immune system caused by the virus, with evidence that this imbalance sometimes is not restored for weeks to months. This is an area of intensive research but without proven treatments yet.
5. Question: Please explain the VAERs data that people who seem to me to be conspiracy theorists keep citing. For instance, have tens of thousands of people died within three days of vaccination?
Answer: The Vaccine Adverse Event Reporting System, or VAERS, is a database run by the CDC and FDA to collect data on any symptom following vaccination that could possibly be due to a vaccine side effect. VAERS helped to uncover the rare blood clotting problem associated with the J&J vaccine, and the equally rare problem of myocarditis in mRNA vaccine recipients. Misuse of VAERS comes about when the data on problem in vaccinated individuals is not compared to a control population that has not received the vaccine. In the example that you cite, since 1 in 100 Americans dies each year, when 250 million Americans are vaccinated, a small percentage will die after receiving the vaccine and be reported in VAERS, even though the vaccine is not responsible for those deaths. I appreciate your asking this question, as misinformation is keeping some from being vaccinated, including one member of my extended family who tragically died as a result.
6. Question: A year’s worth of questions and conjectures about the COVID vaccine has made me wonder if I understand vaccines in general. We seem to accept that the COVID vaccine doesn’t necessarily prevent us from getting COVID, but it keeps us from being deadly ill with it. Does this mean that I might get tetanus if I step on a rusty nail, but it won’t make me very sick? I thought that purpose of the vaccines I get is prevention, but maybe I’m wrong. Is the difference in the quality of the vaccine or the attributes of the pathogen?
Answer: The goal of vaccination is to prevent disease but not necessarily infection. Tetanus vaccine is a great example, where the vaccine acts to neutralize tetanus toxin from causing lockjaw but has no impact in preventing infection by the bacteria that makes the toxin. The Pfizer and Moderna vaccines are up to 90% effective at preventing hospitalizations due to COVID-19, but much less effective at preventing infection.
7. Question: I read recently that the vaccines proved to be less effective than scientists had hoped they would be. I guess this was in response to the omicron contagion. But it was my understanding that the vaccines were extremely successful and would have been more so if more people had received them. So was omicron contagion a failure of the vaccine, a result of lower vaccination numbers than we would have liked, or a little of both?
Answer: A little of both. The omicron variant has so many mutations in the viral spike protein that it was able to partially evade immunity provided by vaccination or from prior infection with other variants. Fortunately the vaccines still are highly effective at preventing hospitalization, likely by inducing a strong cell-mediated immune response that can cure infection once it has started. Tragically about two thirds of those hospitalized at UVa with COVID-19 have not received the vaccine.
8. Question: Charlottesville is still considered to be at high risk, so why is it safe to be maskless? What are you advising people regarding mask-wearing?
Answer: I am advising everyone to be patient and stay masked in indoor public spaces until we move from high to low transmission, likely later this month!