Dear Residents:
In response to the ever fluctuating status of the Covid/Omicron crisis, we have again asked Lawrence resident and Immunologist Dr. Marc Sicklick to share his insights and suggestions with our community.
We trust you will find the following of value and thank Dr. Sicklick for his time and concern.
Very truly yours,
Alex H. Edelman
Mayor
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Marc J. Sicklick, M.D., Allergy, Asthma, and Immunology
It’s only been a couple of weeks since my last Covid letter, but the situation has changed rapidly. I’m getting many calls and emails with questions on a daily basis, and everyone keeps getting warnings and reassurances that contradict each other. What we do know is that Omicron has become the dominant strain. We also know that it is much more contagious than previous strains. What we don’t know is how dangerous it is. Is it a mild respiratory virus in the fully vaccinated or the recently infected? How often does it lead to severe disease and death? How much does the risk vary depending on personal health issues? We know that people who are not fully vaccinated (the operative word being fully, meaning including the booster) are at an increased risk of infection and severe disease. Hospital beds are filling up, but mostly with the unvaccinated.
Are the politicians being proactive with mandates or are they overreacting? Should we just open up?
When I was an academic, I had the luxury of time. I could look at a disease and wait until all the data was in before having to make recommendations, no matter how long it took.
As a clinician, I have to make decisions immediately, based on my best clinical judgment. I don’t have the luxury of telling patients that I need to wait a few months before deciding on a path of treatment until I’m 100% convinced that it’s correct.
Given that, my feeling today is that Omicron IS extremely contagious and previous full vaccinations are beneficial for MOST people in attenuating the disease course. However, I have seen fully immunized and previously recovered patients become infected and end up hospitalized. I am aware of a local resident who has now tested positive for covid for the third time. That means that decisions must involve considering reality as it is understood TODAY and making recommendations based on odds. This means giving advice, that in the scheme of the global population, is beneficial, but in a given patient odds mean nothing. They either get sick or they don’t. That is why, when making recommendations for individuals, we strongly advise people not to take chances.
I am not convinced that it is as dangerous as previous strains and, at least in most healthy people, it appears to be basically an upper respiratory infection. In the recent National Football League cases that have been grabbing the headlines and decimating teams, two-thirds were reported to be asymptomatic and the other third were mildly ill. Keep in mind that these professional athletes are a very vaccinated population.
Nonetheless, the real bottom line is that we have a rapidly rising number of infections. We see this in the headlines on a daily basis. We are setting new record highs day by day. At this point in time, we don’t yet know how many of these infections will lead to chronic illness or death.
I also want to stress that neither the absolute numbers of positive tests nor the percentage of positive tests are what should set our policies. They are what drive the headlines. People who get upper respiratory infections can spread the virus, but that isn’t the real bottom line cost of the pandemic. The more critical and more relevant numbers are those hospitalized and those who succumb to the disease. This is what should drive policy.
We need to get through this period. I suspect that numbers will decrease in weeks, not months. I have attached a graph with projections through April 1, with data going back to the onset of the pandemic in New York.
In a couple of months, the population will be divided into three categories: 1) the vaccinated, 2) the recovered, and 3) those that didn’t recover. Never infected and unvaccinated are not a likely outcome. Hopefully, most people will be in category 1 or 2.
For now, as the numbers are peaking in the very near future, we need to vaccinate (and booster), mask, social distance, and avoid crowds. It is just not the time to party or celebrate in large numbers.
For those who have immune issues and don’t mount an immune response to the vaccines, there are new options that are available in limited amounts and should be considered. Drugs such as Evusheld should be available through hospitals very soon for those who did not respond to the vaccines because of underlying immune issues. Note that, this is not an alternative to the vaccines for the general population.
The “old standby” that worked so well, monoclonal antibodies, is not very effective against the current dominant strain and is not being used. There is an omicron beneficial monoclonal that is not readily available.
Newer anti-virals such as Paxlovid are hitting the market for those at risk who are early in their illness. These drugs are currently in short supply and are not for everyone. Certain underlying medical conditions must be taken into consideration before your doctor calculates the risk:benefit ratio for you.
My current conclusion is that we are peaking now; that it is not the time to take chances and that we should have a much better spring.
Sincerely yours,
Marc J. Sicklick, M.D.
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