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COVID vexes even the most patient

University of Virginia immunologist and COVID-19 researcher Dr. William Petri continues to answer reader questions about COVID-19. Send your questions to Lynne Anderson at vanderson@dailyprogress.com, and she will forward them to Dr. Petri.

All professionals say variations of COVID-19 are here to stay. There is documented research that monoclonal antibodies, when given within two days of a positive test, have around a 95% success rate and most patients’ symptoms are gone with 30 hours. Outpatient oral anti-viral treatments Paxlovid and Molnupiravir are becoming available with a prescription and have an efficacy rate of 87%. What early treatments are now available to all people in Virginia, especially in our area? If any are available, can you please tell us where, because when COVID-19 hits, you only have one day to find treatment.

Early treatments are, thankfully, widely available. The two pills to treat early infections due to COVID-19, Paxlovid and Lagevrio (molnupiravir), are at most of our local pharmacies (of these two pills, Paxlovid is more effective, but many people can’t take it as it interacts with other medicines that they are taking). For the monoclonal antibodies, these are much fewer available in part because they are not pills but need to be injected. Evusheld, which is a combination of two anti-Spike mAbs that is used as pre-exposure prophylaxis for immunocompromised individuals who do not respond to the vaccine, is available at the UVa, Augusta, and Sentara medical center pharmacies. Bebtelovimab, which is the anti-Spike antibody used to treat COVID-19 in high-risk individuals, is available at Augusta and Sentara.

I am 85 years old and have been vaccinated (February 2021) and boosted (September 2021). At Christmas, while visiting family in California, I was infected with COVID-19 — the omicron kind, I assume. My symptoms were mild, and I recovered in a week. Do I now have immunity from BA2? Do I need a second booster shot when they become available? Thank you for taking the time to answer my questions. Your guidance during COVID-19 has been most helpful to our entire community.

You should be immune from serious disease due to COVID-19 omicron sub-variant BA2, as you have been vaccinated and boosted (good for you!!) plus some added immunity from the mild COVID-19 infection back in December. That is when the delta variant was being replaced by the omicron (BA1) virus so you may be even a bit more immune against omicron. I suggest that you wait to get the booster (fourth shot) of the vaccine until May, which will be four months since your infection. The reason to get dose number four is a new study published this month in the New England Journal of Medicine from Israel showing in persons 60 years of age and older that the fourth dose provides added and sustained protection against severe COVID-19.

I — and more than 17 million other Americans — received the Johnson & Johnson vaccine, yet we get almost no information or guidance regarding what vaccines we need now. I had the J&J vaccine in March of 2021, then waited for approval of the CDC to get the Pfizer vaccine, which I got in November 2021. It seems I should get at least another Pfizer in order to be fully vaccinated, as the J&J dropped so its protection so much.

The CDC recommends that you get your first and second boosters with the mRNA vaccines (Pfizer or Moderna). Since it has now been four months since your first booster, I suggest that you go ahead and get your second booster now. The second booster will provide additional long-term protection against severe disease as well as shorter-lived protection from mild infection.

I have read that the second booster confers immunity for only a month or two. Is this correct? And if so, why should we bother?

No, not exactly. The second booster provides added protection against severe COVID-19 in those age 60 and older, with this protection extending out past six weeks (the longest follow-up time so far) with no signs of it waning. To me, this is the major reason to get the fourth booster. You are correct that added protection against mild infection only lasts for about a month, based on the study published this month from the Weizmann Institute in Israel. I just got my fourth shot on Saturday, just in time for a trip to Bangladesh next week (I study parasites there!).

If I had two doses of Moderna, does it matter which booster I get?

No, the CDC says that you can be boosted with either Moderna or Pfizer. (My wife Mary Ann’s critique on my writing for The Daily Progress is that I am like a politician, too indirect in my answers, so I am trying to mend my ways with this very direct answer!). Editor’s Note: We like Dr. Bill’s style.

I have read that COVID-19 would become endemic. Are we there yet, and is that good or bad?

Yes, COVID-19 is going to become endemic, with periodic epidemics just as we see today with influenza. It is a good thing, as infections when they occur will be fewer so as not to overwhelm society, even though they may be just as severe on a case-by-case basis. It is interesting to note that there are four other coronaviruses that cause endemic infections today, and it is likely that each of these was a pandemic when first “spilled over” from bats to people thousands of years ago. By the way, one of the many things I enjoyed as a medical student at UVa was learning Greek and Latin roots of our language. Endemic is from the Greek root en meaning “in” and demos meaning “people”, so literally an infection that is in the people. The epi in epidemic is “upon”, and the pan in pandemic is “all”, so upon the people, and in all people, respectively.

We’ve got major holidays, graduations and weddings coming up. Should we be masking for those events if they are indoors?

I hesitate to say this, as I am so tired of wearing masks, but it makes sense to wear a mask for large indoor public events. We are beginning to see an increase in COVID-19 due to the more transmissible BA-2 subvariant of omicron. Albemarle County is now at a medium level of transmission. At medium transmission levels the CDC recommends that you wear a mask in indoor public spaces if you are at risk for more severe COVID-19. The country has seen a 20% increase in cases over the last two weeks, concentrated in the northeastern U.S. and a little bit here in Central Virginia.

In February, the FDA said to rely on masking for children younger than five in the continued absence of a vaccine, but last month the CDC revoked their universal masking recommendation for childcare programs. My four-year-old is now around unmasked, unvaccinated people (vaccination was never required for teachers) all day at his school. He still masks but has been sick multiple times, and COVID exposed, in a few short weeks. How much should we be concerned about the amount of time he’s spending around unmasked people with a questionable vaccine status since has not yet been granted the protection of a vaccine himself? (It also then means he can’t be aligned with the primary recommendation of the CDC’s new Community Levels.)

I share your concern, and I wish there was an immediate solution. But I don’t see one anytime soon, with not only children but their parents at risk. As you note, the mRNA vaccines are much less effective in children than in adolescents and adults and are not yet approved for six months to five-year-olds. The N95 or the more comfortable KN95 masks are better at protecting their wearer than the loop surgical masks, and together with handwashing will reduce risk. One other hopeful note is that on the horizon are mRNA vaccines that are tweaked to provide better protection against omicron and its BA-2 variant, both for children and adults. And don’t forget that we now have Paxlovid (12-year-olds and up) and Lagevrio (18 years and up) that are pill treatments for COVID-19, although again our children under 12 are left without this protection.

Source: www.dailyprogress.com

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