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Dr. Petri answers COVID-19 questions to help you prepare for the holidays

As the holidays approach, travel and get-togethers are increasing. University of Virginia immunologist and COVID-19 researcher Dr. William Petri, who has answered reader questions about COVID-19 for more than a year, will answer your questions weekly during December in an effort to stop the spread of these diseases at this time of year. Send your questions to Lynne Anderson at, and she will forward them to Dr. Petri.

People seem to think Covid is over; even Pres. Biden has said something to that effect. And I saw Stephen Colbert and Dr. Fauci on TV in a drugstore, and they weren’t wearing masks! Yet I also read that various variants are dangerous and that they holidays could be dangerous for transmission. Can you please sort this out for me? Am I safe to go about unmasked if I’ve had my boosters? Should I mask when I fly? I’m so confused!

I am feeling a little guilty as I write this, as you will find me without a mask this week in the drugstore too! But you too can also go maskless right now because we are at a time of low transmission in Charlottesville and Albemarle County. This is especially true since you have kept up to date with the COVID-19 vaccine boosters.

However, if you have symptoms, a positive test, or have been exposed to someone with COVID-19, then you should wear a mask.

And I wish that COVID-19 was over. I just got home from visiting a dear friend and colleague who is hospitalized and recovering (I pray) from COVID-19, one of 11 patients with the infection currently at UVa. Nationwide last week, the CDC estimates that there were 300,000 new cases, 2,600 deaths and 27,000 hospital admissions. This is the new reality that we are living through, not as dire as the delta and omicron waves of the pandemic we survived, but tragic.

I just read that people aged 65 and older are dying at much higher rates from COVID-19 than other age groups. Does this include people who have been boosted? And if it does, what then should we do to reduce transmission so that we are not endangering oldsters?

You are correct that age and pre-existing medical conditions increase the risk of dying from COVID-19, about sixfold. This is from a recent CDC study from 678 hospitals of one million hospital admissions and 128,000 in-hospital deaths due to COVID-19.

On the good news side of things, mortality overall has dropped from 15% of hospitalized patients during the delta wave to 4.9% with the omicron variants this spring. The improved survival of hospitalized individuals with COVID-19 is likely due to a combination of immunity acquired from vaccination or prior infection and new antivirals, notably Paxlovid. Details on the effectiveness of the bivalent booster below!

I read that the uptake for boosters three and four has been low. Is that across all age groups, or just some? And with COVID-19 at low rates, are the boosters still really needed?

It is hard to imagine anything easier that you could do to reduce your chance of dying than getting a bivalent booster! Apparently, though, a lot of people think the new bivalent booster is not needed, as only 12% of people in the U.S. of five years of age or older (the ages for which the bivalent booster is recommended) have received it. The bivalent booster has mRNA for both the original SARS-CoV-2 from China as well as the BA.5 omicron variant.

There are two recent studies that show how effective the bivalent booster is. One study looked at 360,000 people with positive COVID-19 PCR tests at retail pharmacies in the U.S. The bivalent booster compared with the original vaccine was 30-60% more effective at preventing symptomatic COVID-19. In a second study of 4,000 nursing home residents, the booster was 60% more effective at preventing hospitalization and 90% at preventing death.

Is Covid still evolving – in other words, will there yet again be more variants? And what are the most dangerous variants?

Most of my predictions about COVID-19 have proven wrong, including my thinking at the beginning of the pandemic that the virus would not evolve. I thought we would not see evolution because coronaviruses have a proofreader, much like the autocorrect on our cell phones (but much less annoying!). This proofreader corrects any mutations made when the virus replicates or makes new copies of itself.

What I didn’t consider is that when millions of people are infected, with each infected person making up to 100 billion new viruses, even with spell-check there is tremendous opportunity for the virus to change its spike glycoprotein to evade immunity and spread better.

This week there are new subvariants of omicron called BQ1 and BQ1.1 that have replaced the BA.5 omicron subvariant that was predominant just two months ago. I predict that we will have a pandemic wave of BQ1.1 or its descendants this winter, but due to immunity and better antiviral drugs, that deaths and hospitalizations will not reach the levels that we experienced in past waves.

Are the variants evading the boosters, or are people just not getting boosted? In other words, why won’t COVID-19 go away?

Both, unfortunately. BQ1 and BQ1.1 variants spread faster and evade immunity. Bivalent boosters have been received by only 12% of eligible Americans, despite that fact that the booster gives us substantially better immunity to COVID-19. So there is opportunity lost on a grand scale. I am motivated to write for this reason. If one person decides to get the bivalent booster after reading this column, my time has been well spent!

Do you think we could get a home test for flu like the test for COVID? The symptoms seem to be so similar it would be good know if you had either.

No at-home tests for flu yet, because of a concern at the FDA about their being sensitive and specific enough for consumer use. Hopefully this will change soon, as there are antiviral pills for flu just as there are for COVID-19, and they work best when started early in the illness.

Also, thanks for reminding me to say something about flu, as Virginia has very high levels of flu right now, according to the CDC. Throughout the U.S., we are off to a very early start to flu season, with it reaching epidemic levels now, rather than the first of the year, when it usually appears. Now would be a great time to get your flu vaccine if you have not already done so. Newer flu vaccines that are being given this year provide better immunity, especially to the elderly.

Why have some people never gotten COVID-19?

Nature and nurture. Nature in that some of us have genetic differences that protect us. The best example of this is HIV, where early in the HIV epidemic it was discovered that some people with multiple exposures never became infected. They were found to have a mutation in the CCR5 co-receptor for HIV that prevented the virus from entering white blood cells and causing an infection.

While a comparable mutation in the receptor(s) for SARS-CoV-2 has yet to be identified, there are upwards of a hundred genetic changes that are associated with resistance to COVID-19, including part of chromosome 12 that we inherited from Neanderthals.

The nurture part of the answer likely includes less exposure to the virus by masking, social distancing and vaccination. And of course many people who believe they are not infected may have had an asymptomatic infection and not know it.

Is asthma still considered a serious "underlying disease" equal, for instance, to diabetes or heart disease when it comes to treating COVID-19? Sometimes it’s mentioned by doctors in interviews and sometimes it isn’t. Has COVID treatment advanced (Paxlovid, Remdesivir, monoclonal antibodies.) to the point where asthma is not considered as a major factor in treating mild or severe COVID and therefore not as great a risk for patients?

Asthma severe enough to require medications modestly increases the risk of severe COVID-19. It is much less a risk factor than are age, gender, and other underlying medical conditions such as diabetes, kidney and heart disease.

And anti-viral medications have improved, especially for outpatient treatments. Where there is a gap is in the treatment of patients hospitalized with pneumonia due to COVID-19, where the mortality remains as high as one in eight. Here at UVa, we have a team of physicians and scientists who are working to improve care through clinical trials of new medicines, including a study of a medicine used for asthma called dupilumab.

Since the earliest availability of the Pfizer COVID-19 vaccinations and boosters I have taken all of them (five so far). Sometime after my first booster I had the disease and, even though I am over 90, my case was mild, which I attribute to having been vaccinated. I have asked my primary care physician, my dentist, and several other specialists about the appropriateness of the CDC recommendations regarding COVID-19 vaccinations, etc., and they all expressed their agreement with the recommendations.

Dr. Petri, what I hope you will address explicitly is the problem of well-articulated medical misinformation that is rampant on various websites and the unfortunate fact that millions of people believe such assertions. For example, a very intelligent person I know, who has an MS degree in a challenging technical field, sends me many links to the websites of Lew Rockwell and James Howard Kunstler. These men are quite articulate in their very lengthy discourses about the dangers of covid 19 vaccinations, which they call “jabs”, and the evil intentions of the CDC and many in the medical and pharmaceutical professions.

You raise an important and troubling point. Fortunately there are sources of reliable information on the internet, including the websites of the CDC, WHO and the Virginia Department of Health. And reporting in the major news media I find is more accurate than not. I think each of us can do our part to staunch the flow of misinformation by gently correcting or informing friends of the real data. It is not an easy task but an important part of being a friend.

I had COVID and thought I was better. I had one good day and then – wham! I woke up coughing and sick again. Is this what they call a rebound case? And if so, what causes it, and what can I do to treat it?

This does sound like a rebound case of COVID-19, where the infection after seemingly being controlled, with or without treatment with the antiviral medicine Paxlovid, returns. Why the immune system has not successfully cured the infection in these cases is not known, nor it is known if additional treatment with Paxlovid would help. If it is any consolation (misery loves company), I too had a rebound last spring, and ended up with another five days of isolation in my basement as a result!


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