Summary of Key Points in the COVID-19 Update Presented by Dr. Al Loren, Chief Medical Officer at Northwest Community Healthcare, to NHC Corporate Partners on December 7, 2020
Since the beginning of the COVID outbreak, NHC has admitted and treated over 1500 cases as inpatient and provided outpatient services to many others. During the current “second wave” of cases, NHC has not had to cancel any nonessential services and they urge patients in need of care not to avoid seeking treatment.
Treatment and Testing
Over time, options for treating COVID-19 have improved. The use of Remdesivir, monoclonal antibody, steroids, convalescent plasma and other treatments are producing results with shorter hospital stays, lower mortality rates, and decreased need for ICU treatments and ventilators.
There are two main types of tests administered to detect COVID-19 — viral and antibody. The most sensitive and accurate is viral polymerase chain reaction. Even though antigen testing is often used for screening, it is not the most effective and carries a 20% false negative rate. Antigen testing is rapid at the point of care and best during the first five days of symptoms. The type of test, timing, and type of collection affects the sensitivity of the test.
Those who should be tested include anyone who:
- Is experiencing symptoms of COVID-19
- Has been exposed (for more than ten minutes without wearing a mask) to someone with symptoms
- Has been exposed (for more than ten minutes without wearing a mask) to someone positively identified with COVID-19
- Is preparing for an elective procedure or treatment such as chemotherapy
- Requires a negative test for a job or upcoming travel
It is important to remember that a test measures status at only a single point in time. Someone who tests negative one day may test positive on another day.
Vaccine for COVID-19
Although many are concerned about the rush to produce vaccines, no steps have been eliminated in the process of development. Instead, many steps were completed simultaneously to speed the process. For instance, companies began large scale manufacturing while Phase 3 trials were still in progress so they would be ready to distribute vaccines if the results of the trials proved acceptable.
At present, nine different vaccines are in various stages of testing or production. Pfizer received approval for their vaccine and Moderna’s vaccine is expected to receive approval shortly. Both of these are mRNA vaccines with no virus. (This type of vaccine is considered safer than those using live or attenuated viruses and are quicker and easier to develop.) These vaccines deliver genetic material into cells to create an immune response, causing the host to develop antibodies to neutralize the spike protein on the COVID-19 virus.
Antibodies developed in vaccinated individuals are almost identical to those found in convalescent plasma from patients who have recovered from a COVID-19 infection. Studies to date have been conducted on individuals older than 18 years of age, with approximately 95% effectiveness and no major safety issues. Immunity is obtained seven days after a second necessary injection. Although individuals are not likely to need an annual repeat vaccination, a booster may be required in three years.
Vaccinations will be delivered in three stages, with the first vaccines going to healthcare workers and individuals in congregated living. High risk individuals with certain medical conditions will be next to receive vaccinations. These co-morbid conditions include diabetes, heart disease, pulmonary disease, renal disease, cancer, and other forms immunosuppression. Individuals over the age of 65 are also considered high risk and many of them fall into the category with co-morbid conditions.
The third category of individuals to receive vaccinations will be essential workers including:
- Workers in the food and agriculture industries
- Utility workers
- Workers in the transportation industry
The federal government will allocate the vaccine to state governments and local distribution will follow. The quantity of the vaccine delivered will be based on population size and disease burden. By mid-summer, 300 million Americans should have received access to vaccination.
Individuals who have already had COVID-19 are known to have immunity for 90 days, but after that period, immunity is unknown. Therefore, a vaccine is recommended 90 days after an infection.
Possible side effects of the vaccine include pain at the injection site, fatigue, fever, chills, and muscle aches. These may last for up to seven days. The reactivity rate appears to be less in individuals less than 65 years of age.
Mental Well Being
The pandemic has resulted in an increase in depression, anxiety and substance abuse. Services are available for those in need of assistance.