Controlling COVID-19

Wouldn’t it be wonderful to put COVID-19 in the rearview mirror? Don’t we have enough other life-threatening problems to focus our attention? When is it okay to be normal?
   
Well, there is good news about COVID because the current Omicron variant, while very contagious, appears to cause less severe illness. Yet, especially for those who have immune deficiency, advanced age or other medical problems, it remains unwise to shed all precautions. And although we have learned much about what is effective and what is not, we cannot predict the future course of a changing disease.
   
The best news is that in late December, the FDA approved several medications to be used in the first five days of COVID. From the beginning of the pandemic, we have been hampered by lack of effective methods to treat patients who contract the disease in ways that will avoid severe illness requiring hospital care / ventilators / prolonged therapy and yes, death. All too often, we were delayed in being able to diagnose – and then further frustrated at not being able to treat the illness.
   
Now, we can get timely, self-administered or medically obtained antigen tests as well as the somewhat more sensitive PCR tests done promptly and in time to benefit from these new treatments.
   
In my opinion, Paxlovid is now the best medication, if given early, to dramatically improve the course of COVID. The decrease in the need for emergency room care or hospitalization is reported to be 90%! Paxlovid interferes with the replication of each of the known variants, which stops the progression of the disease, returning the patient to a healthy status within two or three days.

I have had the opportunity to prescribe this treatment, with my first patient being in her nineties. It is simple to use because Paxlovid is in tablet form taken twice daily for five days. It is available in several pharmacies locally, and it is paid for by the federal government.
   
There is another less effective oral medication (molnupiravir), as well as an infusion with one of the monoclonal antibodies (bebtelovimab), or three days of infusion with remdesivir. These therapies are also only helpful when given within the first five days of the illness.
   
So, the strategy for COVID therapy and control is to make the diagnosis early. Be sure to contact a primary healthcare provider who knows about the medications, and begin to take your prescription ASAP. This is so much better than waiting for the illness to progress to the point of needing to have hospital support!!
   
Masks, although far from perfect and annoying for sure, remain a useful way to reduce the risks of spreading COVID to your friends, relatives or your enemies, for that matter. The best masks are the N-95 ones that I wear or the available KN-95’s. Surgical masks are less helpful, and cloth masks really are only helpful when they contain a surgical mask within them.

Correctly wear a mask (over nose and mouth without gaps) to protect yourself when in a confined space with others, especially when unsure of their status. COVID is sneaky in that a person can be totally symptom-free and still be contagious. Unfortunately, there is evidence that an infected person is most contagious the DAY BEFORE they know they are ill.
   
Oh, and if you are in one of the high-risk groups, do get some of the high-quality masks and use them when in a closed space with anyone. For those not in high-risk groups, think “Golden Rule” – “do onto others as you would have them do unto you.” Being considerate of others is oh, so reasonable when you think that way.
   
Vaccines remain extremely important in offering protection – however, not perfect protection – from the most severe COVID infections. There is increasing evidence of the safety of these vaccines, yet many people remain hesitant to get them. If you have been waiting to see about the vaccines, please take some time to look at the data again. They are not perfect – not even as good as they were initially thought to be – yet, the evidence is strongly in their favor—unvaccinated people die 10 times more often from COVID-19 than people fully vaccinated and boosted.
   
Any time now, the FDA will likely release the other vaccines in development, and the experts are considering making changes for future vaccines based on their best estimates of what variants we are likely to encounter.
   
So, there is progress – we can cope with this disease.
   
Keep up with the vaccines and boosters according to the best available evidence.
   
Use a high-quality mask when indoors for self-protection as well as to protect your neighbor.
   
If you think you might have COVID – get tested ASAP, and use Paxlovid or one of the other authorized treatments.

Jim Redka, MD, is a board-certified family physician practicing with FPC Cornerstone and past president of the Lycoming County Medical Society.
Published 04/23/22

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