COVID-19 Update 1/19: Omicron, Boosters, & Endemic Illness

On this week's COVID-19 update, Dr. Bishop provides an update on the Omicron wave, discusses the potential of another booster shot and what the future of boosters might look like, and explains a likely shift to thinking of COVID as an endemic illness. Watch the video below and read on for the full recap.

Omicron Update

It appears that we probably have peaked, or reached the peak of the omicron wave. And we might be about to be on the downside of that.

Looking at case numbers both nationally and here in Virginia, it looks like we've sort of plateaued and maybe even have started to come down a bit. Again, speaking of Virginia, we've gone down from about 15,000-16,000 cases a day to 10,000-12,000 cases a day over the last couple of days.

I think we'll continue to see that slide over the next couple of weeks. Hospitalizations will then probably follow a similar pattern, but a week or two behind, lagging behind the case number drop.

And I think that's corroborated by the fact that the positivity percent and the testing have started to drop as well. It was almost to the upper 30s, and now it's in the low 30s and coming trending down.

So I think by the end of January we'll be solidly over the hump and probably well into the downswing of the omicron variant wave at this point. And that's a great thing. That will be good to be through that.

The main thing with omicron is to continue to be vaccinated. Most of the people who are hospitalized and not doing well with omicron are people who are not vaccinated. Vaccinated folks or people who have had COVID before seem to mostly be doing fairly well with omicron. It's a fairly minor illness for them.

But the folks who are not vaccinated, that is still tending to be a lot more serious, and we're seeing the hospital number corroborate that.

Again, this is my every couple week plea, if you haven't been vaccinated, please consider doing so at this point.

I think it's just the wisest thing to do for your own personal health. Please go ahead and do it.

Boosters

And speaking of vaccines, let's talk a little bit about boosters. I've seen some questions come across, we've gotten questions lately at our offices about, do I need a fourth dose of the vaccine?

The CDC has changed some of its recommendations just this past week. If you are someone who has an immunocompromising illness — meaning your immune system is not normal for a host of reasons, you're under treatment for cancer, you have some specific immune system problems, something like that — then they do want you to consider getting a fourth dose five months after you got the third dose.

Other people, it's not clear yet that that's necessary. I would continue to hold off on that. There is no specific recommendation for that.

Now, I will tell you, a big study came out of Israel that was released yesterday where they did a trial looking at a fourth dose for their elderly population and found that it was not effective at really significantly reducing the risk of getting the omicron variant specifically. So there are some questions about the fourth dose.

I did not see any data released that the CDC based this recommendation for a fourth dose on and so because of that limited dataset, and the Israeli data coming out, for folks who are immunocompromised, I would actually consider talking to your physician about whether you should get a dose of the Evusheld, which is actually one of the injectable antibody treatments that's for pre-exposure prophylaxis.

I've been using it some more in my own patients who are at higher risk for getting COVID because I think the data is good in terms of preventing infection. It's probably perhaps a more robust solution at this point than getting the fourth dose, just again, because of the limited dataset we have on a fourth dose.

Again, that's called Evusheld. It's another one of these monoclonal antibody treatments that's an injection — it's actually two injections — but it's used to prevent COVID in very high-risk people who either are not vaccinated for some reason or who have been vaccinated but their immune systems may not be normal for one reason or another.

If you fall into those categories, I would talk to your doctor about whether you should get a fourth dose or Evusheld, or both. If your doctor thinks you're high-risk enough, that's also not an unreasonable thing to do.

Endemic Illness

I wanted to talk a little bit about this idea of endemic illness. The United Kingdom, in the next few days, is actually going to be ending many of their mitigation practices across their country, because I think they have come to the realization with their public health authorities that the virus is most likely going to become an endemic illness. It's not going away.

And that's really what we've been saying for quite a long time at this point. And I think you will eventually see that sort of language come into play here in the States, that the virus isn't going anywhere.

We're not going to be able to contain it. We're not going to get rid of it. It's going to be with us. We really are going to have to figure out how to integrate this into our daily lives in the years ahead.

And I think along with that is going to come some changes in the way we deal with masks, the way we deal with isolation, the way we deal with testing. But also, the way we deal with the vaccination piece.

Right now, there's a lot of data flow. There's a lot of uncertainty about when do I need a booster, when do I do that, do I need another booster yet? It's been a few months, etc.

I think what you'll eventually see is everything sort of settle out to an annual booster. I think that's the simplest thing. I think asking people to get boosted more than once a year is impractical for the long term. And so I think we will eventually get to, okay, we're going to get our annual COVID booster, just like we get our annual flu shot.

That's going to be sort of the thing that we do, and I think that's fine. I think that's a healthy way to start to integrate this.

Again, the virus isn't going anywhere. It is still very serious for a lot of people. Vaccines are the best protection, far and away, from any other measure that we have. So getting vaccinated once a year, along with your flu shot, is probably going to be the smartest, safest thing to do for the vast majority of people.

That will allow us to move forward eventually, dealing with this on a long-term basis. I think that's likely going to be the theme of 2022. How do we start integrating COVID into our society?

Because it's not going away. And different people are going to come through that process at different paces. And I think that's okay. And I think that's the key thing to remember with this, is that everybody's going to come through that integration process at their own pace.

Some will be faster than others. Some will be slow, and that's okay. I think that's fine. People need to be able to integrate this at a pace that's comfortable for them and that allows them to continue mitigating the risks that they feel they have personally and in a way that they feel is good for them and their health, and I think that's a fine thing and a good thing.

N95 Masks from the Government

"How do we get more N95 masks from the government?"

Yeah, so for those of you who feel you are high risk enough that you want to wear a mask, I think moving over to a KN95 or an N95 mask is probably the smart move to make.

CDC has recently come out saying those masks are in fact better than the cloth or other masks. And I don't know just yet how to get those N95's from the government. That announcement just came out and I haven't seen any details on that.

I know if you want to order tests now, there's a US Postal Service website where you can order those as well from the US Postal Service. 

But I have not seen how to get the N95's just yet. So perhaps that information will be out in a day or two, so great, great questions.

Vaccines and Mutations

"I read an article that said it was important to get vaccines because it can help stop viruses from mutating. Is this accurate?"

I think that's a really complicated question that doesn't have a simple answer. It will help in terms of the more people that are vaccinated, the fewer people will have circulating virus at any given time, which will lower the likelihood of a mutation.

I don't think we will get mutations to stop happening, even if everyone was vaccinated, because the vaccines don't stop transmission at a 100% rate, nowhere near 100% rate. We all know that at this point. So you will have still have a circulating virus even if most or all people are vaccinated.

And if you have virus in any person, you have mutations that can develop. So yes, vaccination will help. Will vaccinations prevent new variants completely? No, it probably will not. That's my opinion on that.

Long COVID and Omicron

"My biggest concern is Long COVID. Any stats on that with omicron?"

Yeah, I was just talking about that with another group. I have not seen stats on that yet. My guess is it will be less because the illness is less severe. But we don't know yet. I know a lot of the folks who have gotten long COVID are getting better. It's just taking a long time. So I think that's good. It just may take some time, but I have not seen as many reports of that with omicron. And I think it's because fewer people are getting severely ill. But you know, time will tell with that just yet.

I think the thing is, I think the true incidence of Long COVID is much lower than we initially feared. I know some of the physicians who are running one of the Long COVID clinics up at VCU, and I think it's not as common as we initially feared. And most people are recovering at some point. So that's great.

Omicron More Than Once? 

"Is there any data coming out sharing if people can get the omicron variant more than once?"

Don't know yet. We just don't know yet. Hopefully not. I would suspect not because there is some early data showing that people who get omicron have backward-looking immunity to delta, not necessarily the other way around.

So if you've got good immunity to the prior variants of COVID, I suspect that you will be less likely to get omicron a second time as well. But we don't have any hard data on that just yet. 

When is the next update?