All my troubles seemed so far away
Now it looks as though they’re here to stay
Oh, I believe in yesterday
I’m not half the man I used to be
There’s a shadow hangin’ over me
Oh, yesterday came suddenly”
I will apologize in advance if this blog ends up meandering all over. Will try to touch on many topics that have been in the media and asked of us in the office including what we might expect regarding disease burden, the Omicron variant, the Poseidon variant, restrictions, new therapeutics, vaccines for youngin’s, and a partridge in a pear tree. Just messing with you on the Poseidon variant. They haven’t named the next one yet….but it’s coming, and it will have a new name. In the immortal words of George Carlin, that’s “spooky language.”
Let’s start today with the elephant in the room….The Omicron variant. Since the beginning of the pandemic, there have been numerous variants that have emerged to infect enough individuals that they got their own name. This is the nature of all things viral, and not in any way surprising. All have some special skills that set them apart. Some spread quicker, some more lethal, some give slightly different symptom profiles. One thing however has been in common with all COVID variants to date: they all suck.
The current variant of concern is the Omicron variant. In both South Africa and the UK, it has rapidly become the dominant variant. It is now popping up everywhere else, including our backyard. Expect that it will take hold here as well. Preliminary data from the UK points to the fact that this is really good at infecting folks, including the vaccinated and previously infected. Other preliminary data seems to imply it may be less lethal. We are about to find out over the next three weeks whether that will in fact be the case, as you will see when we pivot to discussing disease burden in a subsequent section.
I know there is more you want to know about this, including whether you need to start wearing your hazmat suit to go to the supermarket, and will try to address these concerns throughout the subsequent sections.
It’s been awhile since I presented data on disease burden. Brace yourself, it ain’t pretty. There is a major silver lining for about 70% of you however.
The pictures below speak for themselves, and if you are visually impaired, the following explanation will fall on deaf ears.* The case numbers for Suffolk County are skyrocketing over the last couple of weeks. The curve looks eerily similar to that of the last two waves we survived. Case numbers are represented in the left most panel below. Hospitalizations, the first lagging indicator for disease severity is also showing an uptick. It is too early to tell, though the slope does not appear as steep as the prior wave due to Delta. There are many possible reasons for this ranging from the current variant being less lethal, increased vaccination coverage, and lower age of those affected, to name a few. The hospitalization curve for Suffolk County is in the middle panel below. The final lagging indicator, representing a flat line on an EEG and EKG (aka, a condition known as death) is also starting to show another uptick. It is way too early to assess what the fatality rate is going to be with the current variant, but we will definitely see a further uptick from current over the next few weeks. Fatalities in Suffolk County are represented in the right panel below. All panels pillaged using the Newsday Covid Tracker tool.
*If the pictures are speaking to you, you might enjoy the Yellow Submarine movie. You may also want to consider seeking some medical care.
What You Should Be Wishing For This Holiday Season
Primary on the wish list is that this new variant is in fact less lethal. If it is, and spreads as advertised, it may be marking the end of the pandemic as we know it. There is precedent to this, and it generally happens about two years into a pandemic. Before you start cracking open that celebratory drink, keep in mind that even a less lethal virus that spreads many fold faster can still cause a ton of problems in the short term. Among them are overwhelming a health care system and quite a large number of fatalities. Since I know a lot of you love math…..If a virus has half the rate of fatal outcome but infects ten times the number of people in a time period, there are five times the number of deaths in that time period.
Second on the wish list item is a Covid vaccine or booster if eligible. More on this shortly.
Honorable mention: A few less Knicks in Covid protocol. This team needs to gel and get on track already.
The Beatles performing “Don’t Let Me Down” on the rooftop in their final live appearance as a band
Does the vaccine work?
The answer is a definitive yes for all ages five years and older. Your odds of getting Covid if vaccinated are markedly reduced. While there is a five fold increase in breakthrough cases with the Omicron variant (both for vaccinated and previously infected individuals) relative to the Delta variant, the vaccine still performs well. That performance is improved with a booster dose. As has been said over and over the last few years…..don’t take your eyes off the prize. In the end, you can deal with a positive test and nuisance cold symptoms. Your goal is to stay out of the hospital or a pine box (unless you are a vampire). The vaccine does a great job of that. If you have not yet gotten it as an adult, stop playing Russian Roulette, one of these trigger pulls is going to be live. I have seen enough of the parents of children in this practice with an oxygen requirement, cardiac issues, or neurologic issues directly attributed to Covid first hand. These are not issues a young parent needs to deal with. And your kids need their parents.
The Vaccine for Little Folk: Why We Perform Trials
Data was released last week from Pfizer in the younger age group, ages six months to five years. While no concerning side effects were noted, the vaccine did not appear to work well for them either. The primary endpoint looked at was neutralizing antibody titers. As has been noted in prior blogs, these are a proxy for protection, but in a low risk group are about as good as it gets. Titers for the younger age group were not comparable to the older ones previously studied. That being said they also used a far lower dose. Could they need a higher dose? A booster? These are topics for further study before any attempt at vaccinating this group on a large scale can occur. That will take several more months at minimum to conduct.
Further Commentary Regarding the 5 to 11 Year Olds
The last blog discussed the data on the 5 to 11 years of age group, and the gaps that remained at that time. We are now a full six weeks post authorization under emergency use guidelines for that age group. Millions of doses have been administered. To date, there have been no red flags thrown regarding rarer side effects. This is great news. For those on the fence still, you can start getting more comfortable. Historically by two months post release, those types of side effects are already known. And since I am asked daily “Did your 8-year old get the vaccine?,” the answer is yes she did (this week in fact).
Only in this country can we have easy access to a no-cost life saving preventative, yet consistently make the poor choice of not availing ourselves to it. That we barely make the top 20 as a nation in terms of vaccination rate is horrifying. We have lost over 800,000 country-mates to this illness. That’s about 1 in 400. The only thing this decision making process may assist with is lengthening the time until we bankrupt the social security system.
Some Graphs to Wake Up To
When looking at the charts below, please take note the end dates as those for the US lag behind Switzerland. Even if our chart does not end up matching Switzerland, the take home message is very clear. If you are not vaccinated, you have a target on your head for poorer outcome from Covid. May it’s just waiting for Maxwell’s Silver Hammer.
New Medication Approved
Pfizer released results this week from a trial of an oral therapeutic candidate, Paxlovid, for treating Covid. The study was conducted in high risk adult patients and demonstrated an 89% reduction in hospitalizations or deaths. No deaths were reported in those receiving the medication as compared with 10 deaths in the placebo group. Expect this medication to be considered shortly for emergency use authorization. This has the potential to be a real game changer for the high risk individuals.
Question of the day: If you are not getting vaccinated because it’s so new, are you going to take the new medication when you are sick with Covid?
Existential question of the day: If society has little supply of a game changing medication, does it offer it to the high risk vaccinated person or the non-vaccinated person?
The Beatles performing “Revolution”
Politics and Covid
Generally speaking, the time has come for our politicians to STFU as it pertains to pandemic science and medicine concerns. I lay at their feet a large part of the blame for how things have progressed. I mean this in a non-party line manner. Their behavior has seeded doubt in science and medicine, and induced folks into making decisions about their health based on political views. The result is our country has a vaccination rate that is lower than many countries despite the fact that we have a ton of supply. We have witnessed so many unnecessary deaths it’s nauseating. Never mind the continued downward spiral of mental health in this country as collateral damage in this pandemic.
Now I will rarely delve into politics, and in no way have an affiliation or preference for either of our two major parties in this country, but will call out our Vice President today for a comment that either represents a bold faced lie or such rampant ignorance it’s embarrassing.
This week, Kamala Harris stated “We didn’t see Delta coming. I think most scientists did not — upon whose advice and direction we have relied — didn’t see Delta coming,” she said. “We didn’t see Omicron coming. And that’s the nature of what this, this awful virus has been, which as it turns out, has mutations and variants.”
I might have let it slide if not for mentioning the scientists. It hit too close to home. And for that I am calling “bullshit.” If they didn’t see it coming, they haven’t been listening to the scientists. Even Dr. Bunsen Honeydew and Beaker could have advised them better.
One more political bone to pick for today….and only because it impacts our backyard. And that bone(head) would be the current Mayor of NYC, Bill DeBlasio. The mandate that children be vaccinated to go places in the city is inappropriate. While I am at peace with giving the vaccine to that age group, the fact is the vaccine is still only authorized under emergency use protocols. Mandating a non-fully approved vaccine is a move that basically states he thinks he knows more than the doctors and scientists. Last I checked, he has absolutely zero training in either domain.
Capacity issues and burnout during the pandemic have been discussed at length in the media as it pertains to hospitals. What has generally been overlooked is the effects on the delivery of primary care. If you’re an adult, many of you have experienced offices that are refusing to see any sick patients and are sending them straight to the urgent care or the emergency room at the local hospital. For a general pediatric practice things tend to be a bit different, and very few will turn away all sick patients.
At Peds First, we set up an acute care site early in the pandemic to insulate the main office in order to continue to provide appropriate well care, lactation nurse services, psychological services, and all sorts of non-infectious concerning issues to our clients. That space was initially not intended for such use and has limitations on its physical capacity. This limitation is compounded by the inability for a provider to go between types of visit – they are either scheduled for well child care or acute care – running back and forth is not a real option most of the time. Oh yeah….the added attraction on capacity – providers can get Covid after vaccination like the rest of you. And that means quarantine. Imagine a rotation of quarantine in an office already strapped for capacity. Such is our reality.
The last few weeks we finally broke a bit. For the first time in our history we turned away folks seeking acute care. To put it in perspective, last December was pretty busy for as the winter Covid wave was crashing down. By the 13th of this December we surpassed last year’s visit volume. It is impossible to scale a business of our nature on a dime sufficiently. You are likely seeing similar issues elsewhere should you be driving past one of the better known urgent cares with lines around the corner.
Our staff was forced to draw the line the last few weeks because we have been staying a couple of hours late during the pandemic. Every single day. It’s one thing to step it up for a few weeks here and there. Maybe even a few months. It’s two years now. We are tired. Our families want to be together and we need to be there.
Why do I mention all this? A few reasons. First, I want you to understand that our staff loves what they do. What they want to do is look after the health and general well-being of our patients and their families. It’s why we have tried to even help parents and grandparents out in obtaining testing when needed or providing vaccines to them. They want to see you happy. Second, with that understanding comes my first plea to y’all. We know that everyone else is also burnt, frustrated, and generally stir crazy. Please please me and think twice before yelling and cursing at them. It is starting to break our spirit. It is non-stop, all day long. Third, and another plea to y’all. Please have the courtesy to cancel your appointment if not coming for it. Nearly 15% of the same day scheduled acute care patients do not show for their visit. With the courtesy of calling to cancel, we could accommodate many more of you each day. Remember, we really want to help you. Please help us accomplish that for as many as we can each day.
And for the final plea of the day, please get your Covid vaccine if you have yet to do so. I am not asking because I am scared your gonna kill me. I have even gotten my booster. I am asking because if you give me a cold due to Covid I am gonna have to quarantine. In all honesty, I might cherish that. I have literally taken less than 15 days off since this pandemic started to ensure we continue to serve the community to the best of our abilities. I am asking you for your own sake. I don’t want to see more of you suffer unnecessarily, or your children, as a result of your inability to care for them. As a bonus plan, perhaps when you, or a member of your family needs something basic like their ear looked at they won’t need to go to an emergency room. Or worse, when they need their appendix removed that same emergency room will not be so backlogged that they don’t get seen in time before it ruptures. This is your reality.
I know the next few weeks are gonna be hectic for everyone. We at Peds First wish you and your families a happy and healthy holiday season. May the New Year bring us the end of this pandemic and closer together as a society. Today’s Beatles theme was in part because I just watched “Get Back” on Disney Plus, but mainly because while there is little American’s agree on – enjoying the Beatles in some manner is nearly universal. Now go and be excellent to each other.
Post authored by Jason Halegoua PhD, MD, MBA, FAAP. Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004. In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.