Take a Pause - And a Few Covid Updates
MEDICAL AND MENTAL HEALTH UPDATE
The week between Christmas and New Year’s is one giant pause. It reminds me (in the best possible way) of being on hold with a Verizon representative—eagerly awaiting word that your payment was received, the sound of violins searing into your ears, a smidge of wonder about the location of your phone mate who stepped away for “one moment, please, while I access that account.” India? Pakistan? Tulsa? We stop to imagine.
Similarly this week, we pause between holidays to envision the New Year. We pull up templates in our mind’s eye—January: cold! Going back to work: grind! Yoga: do it! But this year, the contours of daily life in 2021 are more difficult to imagine.
Many of us are anxious to get a jump on January and rest assured that 2021 will be the year that crushes COVID-19. I myself want to plan, plot, and press on!
My patients, too, are naturally anxious to sketch out the future. As such, I’m getting a lot of excellent but currently unanswerable questions. (I covered some of them here.) When will you have the vaccine in stock? Where is my spot in line? When will we be able to stop wearing masks? How long does immunity last? Will I be able to resume in-person flute lessons in the fall of 2021?
I get it! Dangling the promise of a vaccine without the certainty about actually getting it is like visiting a candy store that’s closed upon arrival. With your nose pressed against the window, you can taste the swirly pink and green swizzle sticks in the corners of your cheeks, but they cannot be yours—not today.
It’s cruel.
So today I’ll provide you with some certainty—some things that we DO know about the coronavirus vaccines, the UK and South African coronavirus variants, and monoclonal antibody treatment for COVID-19—as we wait for more information (and the dawn of 2021) together.
First, monoclonal antibodies. These are the laboratory-created clones of actual antibodies made by people who have successfully recovered from COVID-19. They are an under-ultilized yet widely available treatment for newly-diagnosed COVID-19 patients who are not sick enough to be in the hospital. Given as a single infusion to a sick patient, they can prevent hospitalization and severe complications from COVID-19.
If I were sick and met criteria, it would be a no-brainer to get an infusion of either Regeneron’s or Eli Lilly’s product. But, as the New York Times reported last week, doses are sitting on hospital shelves at the very moment we need these treatments the most! As COVID cases skyrocket, we are desperate to keep people out of the hospital!
Who is eligible for these treatments? Patients who have a positive COVID-19 test, are within 10 days of symptoms onset, and who are at high risk for progressing to severe COVID-19 and/or hospitalization. This includes anyone at least 65 years of age and those who are obese or have medical conditions like diabetes.
So how can you get monoclonal antibodies if you are newly diagnosed with COVID-19 and meet criteria? Call your doctor. And if your doctor doesn’t know where to send you, you can call Eli Lilly’s hotline at 1-855-545-5921 to find out. Regeneron has recommended that patients or doctors reach out to their local health department.
Bottom line: be persistent! While the administrative process is opaque, the benefit of these treatments is pretty darn clear and the risks very, very low.
Next, the UK and South African coronavirus variants. While the story of more highly-transmissible versions of coronavirus definitely catches my attention, it’s not something I am losing (more) sleep over. At the end of the day, there isn’t any practical implication of this plot line other than to double down on the known risk mitigation measures to protect ourselves from COVID-19. In other words, it’s normal and expected that viruses mutate. Specifically, viruses naturally select for variants that are more contagious. The big question is whether these variants have outsmarted the current vaccines. The short answer is no. The vaccines should work fine until there is “pressure” on the virus to mutate and evade the vaccine—which won’t be for at least a few years. By then, we may need a booster like we need a flu shot every year. And with the sophistication of mRNA vaccine technology, creating a new vaccine would “simply” require entering a new genetic code into the formula—kind of how we change our Gmail passwords every so often to evade intruders. Our Gmail account is still right there; just with a new access code. In my humble opinion, we needn’t freak out about these variants any more than we already are freaking out about the state of the pandemic itself.
And last, the vaccines. The Pfizer-BioNTech and Moderna vaccines are nothing short of a miracle. They are safe, effective, and, frankly, our only way forward. The only people who should take special precautions when getting these vaccines are people with a history of anaphylaxis to other vaccines. (People with allergies to grass, mold, pets, peanuts, antibiotics, etc should be fine.)
Some other quick answers to vaccine FAQs from my patients are here:
You do not need to be tested for COVID prior to getting the vaccine.
If you have a vaccine scheduled and you’ve been exposed, you should wait to get vaccinated until you have completed your quarantine.
If you are sick with COVID-19, you should defer vaccination until after your isolation period is over.
If you’ve already had COVID-19, CDC recommends deferring vaccination for 90 days since it is exceedingly rare to get reinfected during that time period.
Emergency use authorizations for the Astra Zeneca and Johnson & Johnson vaccines should be coming in early 2021.
You will not be able to choose which vaccine you get any time soon as they are in short supply.
The two-dose vaccines are not to be given interchangeably.
We don’t yet know which vaccine (if any) is better for certain ages, genders, ethnicities, etc. For now, I would be happy to receive any vaccine that the FDA approved.
And finally for my patients: the DC Department of Health has not yet indicated IF and WHEN my practice might obtain doses of the vaccine. I imagine we will get the Moderna vaccine first (due to the extreme cold temperatures required to store the Pfizer vaccine), but this is only a guess. I’m not keeping a waiting list because in my mind every patient who wants the vaccine is “on the list” and will get it based on CDC guidelines and our allotted amounts—though it is certainly possible that Walgreens and CVS will get it before we do. We just don’t know. But I promise I will keep you updated! Your health, wellbeing, and access to information is my top priority!
Last but not least, my two cents of mental health advice: TAKE the pause. Enjoy being on hold. Relaxing amidst uncertainty is a skill—and one that many of us are getting better at every single day, whether we like it or not. So perhaps like you, this week I’m relishing leftovers, low expectations, and the lull between holidays. That’s for certain!
I will see you later this week. Until then, be well.