Dr. William A. Petri, an immunologist at the University of Virginia School of Medicine, answers this week’s reader questions on COVID-19. Dr. Petri will keep dishing on COVID-19 and answering your questions each week in The Daily Progress for as long as you have questions. Send them to Editor Lynne Anderson at: email@example.com, and she will forward them to Dr. Petri.
With holidays approaching, is it safe to travel? It is much safer to travel this holiday period compared to a year ago. Mary Ann and I are looking forward to our adult children visiting us! The major reason things are better is that 70% of the U.S. population 12 years of age or older is fully vaccinated. The vaccines are providing sustained 80-90% protection from disease due to COVID-19. In fact the most recent data from the CDC shows vaccinated adults being 14-times less likely to be hospitalized or die. While vaccine-induced protection from less severe infections had dropped six months after vaccination from 90% to 60% effectiveness, the approval of boosters last Friday for everyone 18 years of age and older will restore vaccine protection against infection back up to as high as 90%.
There are several things that you can do to make the holidays safe. First, ensure that you and your family members ages 5 and older are vaccinated. Second have everyone age 18 and older boosted (the booster is needed 2 months after the J&J vaccine and 6 months after the Pfizer and Moderna vaccines). Third, continue to wear masks in indoor public places and stay 6 feet away from others. Fourth, be extra careful if you are traveling to an area of high transmission such as Michigan, Wisconsin, Minnesota or some of the New England and mountain states, as they are having up to ten times the amount of COVID-19 that we are in Central Virginia. Finally at family gatherings have the non-vaccinated stay masked and remind everyone not to attend if they are feeling ill or were recently exposed to someone with COVID-19, and
Symptoms that could be COVID-19 include fever or chills, shortness of breath, body aches, fatigue, headache, loss of taste or smell, runny nose, nausea, vomiting or diarrhea. If you have any of these symptoms you should isolate yourself at least until you can be tested.
Remember too at family gatherings that extra care should be taken to protect those who are more vulnerable to COVID-19. The greatest risk factor for more severe COVID-19 is of course not being vaccinated. The second greatest risk group is our seniors: an unvaccinated 75-year- old is 100-fold more likely to die than a 30-40 year old. Other conditions placing individuals at higher risk include pregnancy, obesity and serious underlying medical conditions including solid organ and stem cell transplants, heart, liver or and lung disease, diabetes, cancer, and neurologic disease including stroke and dementia.
What is going on with boosters? It is much less confusing now, thankfully! As of last Friday, boosters are approved for all adults age 18 and older. If you had the Johnson & Johnson vaccine 2 months ago or the Moderna or Pfizer vaccine 6 months, ago you should get a booster shot. It really doesn’t matter which vaccine you get as a booster, as a study at the Universlty of Maryland showed that all three vaccines work quite well to boost your antibody titer against the spike glycoprotein.
With so many breakthrough infections of COVID-19 with the fully vaccinated (including booster shots) why aren’t the health care system staff being tested weekly? The fully vaccinated may have minor symptoms or maybe no symptoms but can still spread the virus, especially to immunocompromised hospital patients. Great question, thank you. Here at the University of Virginia Hospital you are correct that we are not testing vaccinated asymptomatic employees for COVID-19. The reasons for this are, first, that the vaccine, when boosted, is providing 90% protection against infection as well as disease, and second that we are universally masking, so no healthcare personnel are interacting with patients in the absence of masking, which we know is effective at preventing spread. All of us in addition have an on-line app on our cell phones where we report each day as we are about to start work if we have any symptoms that could be COVID-19. A few weeks ago for example I had a new cough and runny nose, and I knew not to work that day. I was tested for COVID-19 in the UVA COVID Clinic and knew by lunchtime that I did not have COVID, and therefore was not at risk of spreading it to my patients. Parenthetically it is a sad fact of our new life under the pandemic that we can’t even have a cold without undergoing testing!
On Sept. 18, I received the Pfizer booster. On Oct. 30, I tested positive for COVID. Does my having had COVID-19 heighten my immunity? I don’t plan on changing anything I’m doing, just curious. Interesting and important question. Vaccination increases the naturally acquired immunity from a COVID-19 infection two-fold, so it makes sense that the opposite is true as well. Your particular situation is unusual in that you had a breakthrough infection after being boosted, as we know the booster provides 90% protection from infection as well as disease due to COVID-19. It might be worthwhile to have your health care provider test your anti-Spike COVID-19 antibody, as if you do not have an antibody response I would be concerned that your immune system is not responding properly to the vaccine or to COVID-19. If this were the case, then you would benefit from receiving the anti-Spike monoclonal antibody cocktail that was show in studies done partly here at UVA to both prevent and treat COVID-19.
Pfizer has just asked the FDA for approval for a pill that treats COVID. How effective has the drug been in clinical trials? There are under review at the FDA actually two different kinds of pills for the outpatient treatment of COVID-19. The Pfizer medicine is called Paxlovid, and it is a protease inhibitor. The new coronavirus needs its own protease to break apart one long protein into the different parts that make up the virus. So the protease inhibitor prevents making new virus. Paxlovid treatmet within three to five days of symptom onset decreased the risk of hospitalization or death by 89%. Molupiravir, made by Merck, is a second oral pill for treatment. Molupiravir is a ribonucleoside analogue that inhibits replication of the RNA genome of the virus; interim analysis of its phase 3 study showed a 50% reduction in risk of hospitalization or death in high-risk individuals who were treated within 5 days of symptoms. The US government is purchasing stockpiles of these medicines in order to provide free treatment at such time as the FDA approves their use. I am amazed at the speed of these new COVID-19 treatments, and am so grateful to the scientists who developed them and the subjects who volunteered for the studies that showed they were effective. Very soon we will have ways, in addition to the anti-Spike monoclonal antibodies, to treat COVID-19 in the community and prevent hospitalizations.
Is it too late for me to get a booster if I want to spend time with my family for Thanksgiving? Will I still receive some immunity?
No, it is not too late, and you should have a boost in immunity by Thanksgiving if you get a shot today or tomorrow.
With all the recent developments – kids getting vaccinated, a possible new pill, boosters in millions of arms – is COVID-19 going to soon be a thing of the past? It is going to take decades of concerted effort around the world to make COVID a thing of the past. We see this with the polio vaccination effort, supported by the Rotary Club, WHO, the Gates Foundation and the governments of the world. The result of their working together is that we are on the cusp of elimination of polio, with the last wild polio virus infection causing paralysis in a child in Pakistan on January 27, 2021. However, this has taken decades of concerted effort to achieve, so while elimination of COVID-19 is something we as a society can achieve, we must work together over a number or years.
I think what will happen during 2022 is a change of COVID-19 from a pandemic (Greek for all the people) to an epidemic (Greek for upon the people) infection, much like influenza. I think the good news is that the U.S. is being generous with donating vaccine for international immunizations, with right now about half of the world’s population having received a vaccine. So we are going in the right direction. I know that on Thursday I will be giving thanks for these advances in COVID-19 treatment and prevention!