As I mentioned about a month ago, Ebola preparedness is back on our radar. Ebola is much more dangerous than Covid but fortunately is extraordinarily uncommon in the US. Nonetheless, we still prepare. We had an Ebola drill in the emergency department this week. We saw several potential Ebola patients in the first go ‘round in America (it presents similarly to Malaria which we actually do see not infrequently) but we’ve been very happy that it has fallen off the radar the last few years. Because there are patients who are from high-risk countries who are self-monitoring in the area, Ebola needs to remain on our radar. Wednesday’s drill was a chance for our amazing emergency preparedness leaders to dust off and upgrade the play book. Preparing for the Ebola patient is a huge endeavor. Our drill involved about 50 people in numerous departments. The facilities team creates a makeshift isolation ward that cordons off several rooms in the emergency department. Three nurses will be involved in the patient’s care. Techs will be involved in the care. Our infection prevention and infectious disease teams are involved. Security is involved. The lab is involved. There are very clear protocols on all aspects of the patient care, ranging from the types of PPE the team caring for the patient wear, the earpieces that are used to communicate among team members, and how waste is disposed of. Arlington EMS participated as well, bringing us a “patient” (who works in the ED office) and going through their own hazmat and decontamination process. One thing you always hear the nurses say is just how hot they get under about 3 layers of protective gowns and double gloves. They are in the rooms much longer than the physicians and I get hot pretty quickly just in my single plastic layer for Covid.
Besides the Ebola drill, I worked two clinical shifts (Monday evening and today’s day shift, thus posting this a bit later than usual), participated in a webinar for the VHC Foundation where I talked about COVID in the ER (I know, right?) for half an hour, spent 30 minutes signing, dating, and initialing 60 recredentialing packets for our doctor and APP team, did a telemedicine shift, had my monthly department staff meeting and our monthly trauma meetings, plus the usual array of staffing and business meetings, and time meeting with nursing team. Honestly, it’s been an exhausting week and I’m looking forward to seeing some vaccinated friends outside this weekend as well as my parents and brother and his wife for a brunch. I think this will be the third time I see my parents and brother in the last year, but this will be the first time without masks and with food.
We continue to see the same total number of new Covid cases as the last several weeks. What is really interesting however, is that our symptomatic patient subgroup has had a steady decline over the last 4 to 6 weeks and our percent positive rate last week was the lowest it has been in 6 weeks. However, for what could be the first time, we had more positives out of our asymptomatic population than our symptomatic population. Numbers wise, we tested about 60 patients last week who were symptomatic and over 320 who were asymptomatic. Those numbers have been pretty consistent for the last 6+ months. However, I do not think we have ever had more positives from our asymptomatic group. The percent positive rate for this group was also the highest it has been in 6 weeks. Covid is clearly still out there and we’re continuing to see patients who require the emergency department and/or admission to the hospital for Covid. On the hospital front, we have the lowest amount of Covid patients who are hospitalized that I can remember in quite some time. Probably similar to last summers plateau. The amount of patients in the hospital right now is probably 25% less than those who were hospitalized when I looked at this on Wednesday. That is great news . And more good news when it comes to our Covid isolation patients. We had a noticeable drop in the number of patients who required Covid isolation status, having the least number of patients since mid-October. Of this category of patients, were also seeing the lowest admission rate since mid-October as well. As I did my clinical shifts this week, it was great to see the number of patients to have completed vaccinations. While I get the occasional patient who is either antivaxx or thinks Covid is a hoax, it seems like the majority of people are on their way to getting vaccinated. I was a little concerned about a few elderly patients who said they just had not made time to do it yet. If you are a high-patient, the most important thing you can do right now is go get your vaccine.
I’ve gotten a lot of questions about mask use and vacations this summer. As I’ve probably said, I walk my dog without a mask though I never get close to people. I also feel quite comfortable being around a vaccinated friend or two outdoors without masks on. The risk is low to you and your friends. My wife and I talked earlier this week about whether we’d go to our favorite beach bar this summer to see an outdoor concert and I told her I’d be reluctant to do it because I don’t think enough people would be wearing masks and I certainly wouldn’t know who was vaccinated or not. Yet, I have no concerns about sitting on the beach with a small group of vaccinated friends. Now, let’s turn to a vacation. I think if you wear a mask and use good hand hygiene, you can probably fly safely enough. Though based on the local beach rental availability, I think the majority of people are looking to travel for vacation via their car. Each decision you make while on vacation comes down to your pre-existing health risk if you get sick and your risk tolerance. Sharing a rental house with vaccinated people seems relatively safe. Going to a resort with crowded restaurants and bars (particularly if inside because you need air conditioning) is higher risk. Although we’re making progress with vaccinations, the new case numbers are not declining enough at this point. I think it’s really hard to predict what the case rate will be 2-3 months from now at the height of vacation season. I’m optimistic it will be better, but I do not see life returning to pre-COVID normal yet. Common sense really needs to prevail. Being outdoors, or even indoors, with vaccinated friends is generally worth the risk, since the risk is low. Going to a crowded environment, particularly if mask wearing is optional, is not for me at this point.
I read a couple of interesting articles this week on the likelihood of needing boosters, as well as on the state of current and future treatments. While it’s too early to know exactly how long the vaccine will keep the immune system active, it’s certainly possible that we’ll need a booster at some point for the variants. I’m happy to get one but am also happy to wait patiently to see what the scientists tell us, as they monitor the immune systems of the original test subjects. Treatments are generally unchanged the last 6+ months. Remdesivir and decadron are key for patients requiring oxygen. For some patients, monoclonal antibody therapy may help in the outpatient setting. But Pfizer is working on a pill that would be used in the outpatient setting to treat COVID. It would block protease, which is an enzyme viruses need to replicate. Protease inhibitors are used to treat HIV and hepatitis C. Certainly getting an effective oral treatment would be fantastic.
As we think about vaccination, it’s very concerning to me that about 8% of people are skipping their second dose of Pfizer or Moderna. There have been some medication mix ups that delayed second shots, but generally, the belief is that people feel one dose will give them enough immunity or they don’t have the time for a second dose, or they are afraid of feeling sick for a day or so afterwards. Certainly, getting COVID could lead to much more than just a day of malaise and fevers and while one dose gives you some protection, it does not give you the optimal protection. A single shot gives you a weaker immune response and leaves you more susceptible to variants compared to fully immunized people.
Getting COVID transmission under control as quickly as possible is about reducing variants. I’m hearing about open slots at vaccination centers and a general falloff in demand. If you’re reading this, it’s likely that you’re vaccinated. Thank you for doing that. We all should be trying to get our unvaccinated friends and family members to get vaccinated. You can get the shot too if you haven’t already. VHC is offering vaccinations—check social media for info.
Science matters. Wear a mask. Practice physical distancing.