ICYMI 👉
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In a special video episode of today’s newsletter, my friend Shira Doron, MD, and I discuss the state of COVID—new variants, testing, treatment, boosters, and long COVID.
Shira is the Hospital Epidemiologist at Tufts Medical Center, an infectious diseases doctor, and Professor of Medicine at Tufts School of Medicine. She is a nationally recognized expert in antimicrobial stewardship and infection control. During the COVID-19 pandemic, she played a key role in helping the general public separate fact from fiction.
I hope you take a listen above!
In addition, here is Dr. Doron’s take on the current state of COVID & respiratory viruses in the U.S.:
Respiratory viral season is upon us. It’s likely that you know several people who are sick right now. These days, it can be hard to figure out how worried to be. Is this a “normal” flu season? Is COVID-19 “surging”? The media is paying more attention to respiratory infections than they did before the pandemic, and the headlines are often designed to garner clicks, which is to say they are sensationalist. Let’s cut through the hype.
Here are a few things to know:
Current state
There are many respiratory viruses circulating right now, most of which are always more prevalent in the winter. You cannot tell the difference between them without a test. Health authorities track a metric called “ILI” which stands for “influenza-like illness.” This metric encompasses all of the respiratory viruses including but not limited to COVID-19, influenza (“flu”) and COVID-19. Right now, where you live determines how much ILI you are seeing.
source: CDC.gov
Trends show that ILI peaked in the last week of 2023 and is coming down. The peak this season was lower than the year before, and comparable to the year before the pandemic, despite the fact that we have a new virus in the mix. In other words, this is a “normal” respiratory virus season in terms of severity.
Testing and treatment
Health authorities still recommend that everyone test themselves for COVID-19 even if they have mild symptoms. That’s because everyone is still advised to stay home for 5 days if they have COVID-19 infection (plus another 5 days of mask wearing). Testing is especially important for people with risk factors for progression to severe disease (such as those over 65 years of age, who have multiple medical problems, are immunosuppressed, or are pregnant), because there are highly effective antivirals like Paxlovid for those who qualify. You should be aware that, while the accuracy of home tests hasn’t changed, widespread population immunity means that the levels of virus in your nose might not reach the detectable threshold until later in your illness, as late as day 4, so keep testing.
If you haven’t gotten the latest round of free tests from the government (announced November 20, 2023), they can be obtained at https://special.usps.com/testkits.
Testing for influenza is indicated if you are within 48 hours of symptom onset and have risk factors for severe disease. Antivirals for influenza can shorten the duration of symptoms. Talk to your doctor if you think you have the flu, which is characterized by sudden onset fever, body aches, fatigue and cough.
It is rarely necessary to test for other respiratory viruses, including RSV, because there are no available treatments for them.
Prevention
Updated annual vaccines are available for COVID-19 and influenza. For the first time, we now have immunizations for RSV too.
COVID-19 vaccines
No longer to be referred to as a “booster,” the 2023-2024 annual vaccine was reformulated to target more recently circulating strains of the virus. Everyone age 5 and older who is not moderately to severely immunocompromised is recommended to receive one annual dose. While vaccination is recommended for all individuals over the age of 6 months, those at highest risk stand to benefit the most. There are three options: the Pfizer vaccine, the Moderna vaccine, and the Novavax vaccine which is a good option for people who need or want an alternative to the mRNA vaccines.
RSV immunizations
Almost overnight, an entire arsenal of preventative strategies have been approved for RSV. They are:
The Pfizer and GSK vaccines for adults over age 60—public health authorities recommend that people in this category discuss with their doctor whether the RSV vaccine is right for them.
The Pfizer vaccine for pregnant women—all women should receive this vaccine if they are between weeks 32 and 36 before the end of January. This will protect their newborn baby from RSV infection. Fortunately, the RSV season is almost over for the year.
The monoclonal antibody, Nirsevimab, for newborns—this preventative treatment has been in very short supply. Talk to your pediatrician if your baby’s mother did not receive the RSV vaccine during pregnancy.
Influenza
Annual flu vaccination is recommended for everyone over the age of 6 months. Patients age 65 and older should receive a high-dose, recombinant or adjuvanted vaccine for greater potency. People with egg allergy may now receive any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status without the need to be vaccinated in a medical setting.
Other preventative measures
If you are high-risk or risk-averse, you may want to avoid crowded indoor spaces where the risk of respiratory virus transmission is higher. You can protect yourself with a well-fitting high-quality mask.
Maintaining your general health will go a long way to helping you successfully weather a respiratory infection, as it is inevitable that everyone will catch one at some point. Remember to eat well, get plenty of sleep, exercise, manage your stress, and optimize your underlying medical conditions like diabetes and high blood pressure.
-Shira Doron, MD
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