COVID new cases and the number of daily deaths across the US have decreased significantly since January. In fact, daily deaths are the lowest they’ve been in 14 months. Although I’m still wearing my COVID uniform at work (scrubs, N95 covered by a surgical mask, goggles, and surgical cap), I can’t remember the last COVID patient I took care of. We’re still testing similar numbers of patients on a week-to-week basis, and still need to consider COVID in our differential diagnosis, but the numbers are definitely down.
The data out of our emergency department looks good. Even though we are having increasing numbers of patients come to the emergency department, the number of patients who require COVID isolation is reduced from prior weeks and significantly below what we saw during our surges. The percent of these patients who require admission is also about the lowest level we’ve seen since April 2020. The numbers of positive cases we identify among both our symptomatic patients as well as all comers to the emergency department, are the lowest numbers we have seen since I started keeping track of data in April 2020. Where we used to identify upwards of 100 new COVID patients a week, we are now down to numbers that I can pretty much count on my hands (and occasionally a foot). We actually had 2 days within the last week where we didn’t have any patients test positive in the ER. That’s amazing. Interestingly enough, I did have a patient test positive for Flu B. Our percent positive rates are also the lowest they have been since I started keeping track of the numbers. All of this speaks to the amount of the population that is vaccinated as well as the efficacy of the vaccine. As an ER doc, I know I will be dealing with COVID patients for a long time. But as vaccination numbers improve and we identify less and less new COVID patients, I know we are that much closer to truly being back to normal and our day-to-day lives.
We are continuing to return to normal within the hospital. ER volumes are trending towards pre-pandemic levels (remember, we were down about 50% a year ago). Discussions are taking place within the hospital about changes to pre-procedure testing and not requiring COVID tests ahead of time for asymptomatic patients. This is based on low levels of COVID in the area, high vaccination rates, and a low positivity test rate. On the staff safety front, we continue to have hospital staff who were initially hesitant to get the vaccine make the decision to get vaccinated and our hospital vaccination rate continues to climb. And in general, when we look at staff who test positive for COVID, none of them are vaccinated. In other words, vaccinated staff are not testing positive, which is more evidence the vaccine works.
Yesterday was a big day for our house because our 15-year-old son got his COVID vaccine. (See attached photo) I know some of you were surprised that he did not get it last Thursday or Friday once it was approved for his age group but that did not mean I was not committed to getting it for him as soon as possible. Vaccination in this age group is critical towards reducing spread and is also safe. The Pfizer vaccine does not impact our DNA and produces no long-term changes to our body outside of the immunity response. Just like in adults, the side effects are arm soreness, which my son is experiencing, and fatigue, fevers, and malaise to name a few things. These are generally short-lived and resolve on their own. There are some surveys that estimate that about 50% of parents are reluctant to get their kids vaccinated. I hope that over time these parents see the safety profile and the importance of getting their children vaccinated. I said previously that every doctor friend of mine has received the vaccine. While there may be a couple doctors out there who are anti-vax, I personally do not know any of them. And every physician friend of mine I have spoken with, either has gotten their child vaccinated or has plans to vaccinate their children. The people who are seeing the effects of COVID firsthand and understand the science behind the vaccine are fully supporting vaccinating the pediatric patient in my experience.
It’s unknown how long immunity will last after a vaccine. I’ve said for months that I expect to need a booster shot at some point. The question is being evaluated now. Both Pfizer and Moderna have studies taking place to see how long immunity lasts and what are the risks/benefits of a booster shot. The Pfizer CEO said this week that he hopes to have the answer in the next one to two months. They are anticipating boosters for the people who got vaccinated last December (healthcare workers) to be needed around September. Meanwhile, scientists in the UK are studying 7 different vaccines in a trial of boosters. I was talking to another ER chair Wednesday night and while we feel very confident with our immunity levels now, almost 6 months after our second dose of vaccine (which studies support), we were wondering if we’d need a booster in month 10, 11, 12, etc….If scientists can determine this by the end of the summer, then we’ll be able to plan to vaccinate the healthcare workers.
I am still very concerned about was going on in India. Hundreds of doctors have died and millions of people are infected. Although there surge seems to have peaked, they’re still having 250,000+ new cases a day. There are new variants emerging from all of the transmission taking place in India and around the rest of the world. But a spokesperson from a World Health Organization said this week that “all COVID-19 virus variants that have emerged so far do respond to the available approved vaccines.” That’s more good news for our current vaccines.
There were two recent studies published (JAMA and the J. of OB/GYN) on the safety of the vaccine in pregnancy. Keep in mind that pregnant women were excluded for the original vaccine studies but since then, the evidence is growing that the vaccine is effective in pregnancy, may transmit some immunity to the baby through the bloodstream and through breast milk, and doesn’t harm the placenta. These are reassuring and add to the growing body of evidence that pregnant women can be safely vaccinated and the baby is not harmed by either the Pfizer or Moderna vaccines.
To close, I had a pretty interesting week professionally and personally, so please indulge me while I share a bit. My son had a soccer game close to the Delaware beaches last Saturday. It was close enough that we could hit the beach for a couple of hours afterwards. I fell asleep and woke up to a few people going deep down the rabbit hole of conspiracy theories. They covered the Capitol insurrection, that Fauci paid money to the lab in Wuhan to create Coronavirus, and that the mRNA vaccines were dangerous. That was our trigger to get off the beach and head to Ocean City to a favorite beach bar/restaurant for a late afternoon meal before we headed back (I would have liked to have stayed but had to work Sunday). So, as we walked into the restaurant, there was a sign indicating they were a mask-less restaurant. That was fine. We were eating outside, and it wasn’t crowded. But it begs the question around the CDC recommendations regarding mask use for non-fully vaccinated people. About 60% of adults have received at least one dose of vaccine but only 48% or so of adults are fully vaccinated. About 38% of our population is fully vaccinated. Maryland is doing better than DC and Virginia but everyone is close—44%, 42%, and 41% respectively. But now I only see about 5-10% of people wearing masks. The country made a big effort to open up last year as Memorial Day rolled around and then we saw cases go up. We’ll certainly track numbers. I also did an interview with Victoria Sanchez from WJLA7. Via zoom, we spoke for about 20 minutes, and on Wednesday, she aired a really nice story about my Facebook posts. (link in comments). Finally, this morning, I was given the Torch Award for Ethical Leadership by the Leadership Center of Excellence (formerly Leadership Arlington). This was really a huge honor and was based on these Facebook posts I’ve been writing for the past 15 months. I can’t thank all of you who read these posts enough for your support and interest in reading about my experience in the ER.
I’m going to change up my sign off from “Science matters. Wear a mask. Practice physical distancing.
”Science matters. Get vaccinated. Wear a mask when you’re supposed to. We’re almost there.