Wouldn’t it be wonderful to put COVID-19 in the rearview mirror? Don’t we have enough other life-threatening issues to focus our attention on? When is it normal to be normal?
Well, there is good news about COVID because the current variant of Omicron, although highly contagious, appears to cause less severe disease. Yet, especially for those with immune deficiency, advanced age, or other medical conditions, it remains unwise to waste all precautions. And while we’ve learned a lot about what works and what doesn’t, we can’t predict the future course of an evolving disease.
The best news is that in late December, the FDA approved several drugs for use in the first five days of COVID. Since the beginning of the pandemic, we have been hampered by the lack of effective methods to treat patients who contract the disease in such a way as to avoid serious illness requiring hospital care / ventilators / prolonged therapy and yes, death. Too often, we’ve been delayed in our ability to diagnose – and then even more frustrated at not being able to treat the disease.
Now we can get rapid, self-administered or medically obtained antigen tests, as well as somewhat more sensitive PCR tests, done quickly and in time to benefit from these new treatments.
In my opinion, Paxlovid is now the best drug, if given early, to dramatically improve the course of COVID. The reduction in the need for emergency care or hospitalization would be 90%! Paxlovid interferes with the replication of each of the known variants, which halts the progression of the disease, returning the patient to a healthy state within two to three days. I had the opportunity to prescribe this treatment, my first patient being in her nineties. It is simple to use because Paxlovid comes in tablets taken twice a day for five days. It is available at several local pharmacies and is paid for by the federal government.
There is another less effective oral drug (molnupiravir), as well as an infusion with one of the monoclonal antibodies (bebtelovimab), or a three-day infusion with remdesivir. These therapies are also only useful when given within the first five days of illness.
Thus, the treatment and control strategy for COVID is to diagnose early. Be sure to contact a primary health care provider who is knowledgeable about medications and start taking your prescription as soon as possible. It’s so much better than waiting for the disease to progress to the point of needing hospital support!!
Masks, while far from perfect and boring for sure, are still a useful way to reduce the risk of spreading COVID to your friends, loved ones, or enemies, for that matter. The best masks are the N-95s I wear or the KN-95s available. Surgical masks are less useful, and cloth masks are only really useful when they contain a surgical mask. Properly wear a mask (over nose and mouth with no gap) to protect yourself when you are in a confined space with other people, especially when you are unsure of their status. COVID is sneaky in that a person can be completely asymptomatic and still contagious. Unfortunately, an infected person is proven to be most contagious the DAY BEFORE they know they are sick.
Oh, and if you’re in one of the high-risk groups, get some high-quality masks and use them when you’re in an enclosed space with anyone. For those who are not in the high-risk groups, consider “Golden Rule” – “Do unto others as you would have them do unto you”. Being considerate of others is oh, so reasonable when you think about it that way.
Vaccines remain hugely important in providing protection – though not perfect – against the most severe COVID infections. There is growing evidence that these vaccines are safe, but many people are still hesitant to get them. If you were waiting to see the vaccines, please take the time to review the data. They’re not perfect — not even as good as initially thought — yet the evidence is strongly in their favor — unvaccinated people die 10 times more often from COVID-19 than fully vaccinated and boosted people.
At any point now, the FDA will likely release the other vaccines in development, and experts are considering making changes to future vaccines based on their best estimates of the variants we’re likely to encounter.
So there is progress – we can deal with this disease.
Track vaccines and boosters based on the best available evidence.
Use a high quality mask indoors to protect yourself and your neighbor.
If you think you have COVID, get tested as soon as possible and use Paxlovid or one of the other licensed treatments.
Jim Redka, MD, is a board-certified family physician who practices with FPC Cornerstone and past president of Lycoming County Medical Society.