COVID-19 – and the public’s appetite for safety measures – looks different these days.
Cases and hospitalizations, which were relatively flat in late March, are slowly picking up in New Hampshire, although they’re nowhere near the numbers we saw in January and February.
DR Aalok Khole
On Tuesday, the Department of Health and Human Services’ COVID-19 dashboard reported 41 hospital admissions, which it now defines only as those treated with remdesivir or dexamethasone. At the beginning of April there were only four. Meanwhile, 56 others are no longer contagious but have yet to be hospitalized, according to the New Hampshire Hospital Association dashboard.
Deaths are increasing even more slowly. In early April, the state reported 0.4 deaths above a seven-day average. On May 11th the latest available data was 1.3.
What’s growing faster are cases of long-standing COVID-19, with symptoms ranging from fatigue and breathing problems to brain fog.
What is not climbing is mask use. The few local mask requirements that were in effect earlier this year have been lifted. It’s rare for a store or restaurant to dictate or even suggest customers use one, and few seem to go for it. And a reliable vaccination rate is hard to find; The Centers for Disease Control and Prevention estimates that 95 percent of the state is fully vaccinated. The Mayo Clinic says it’s 71 percent.
we have dr Aalok Khole, an infectious disease expert at Cheshire Medical Center in Keene, for an update on COVID-19.
The sharp drop in hospital admissions and deaths is good news. But cases of long-term COVID-19 are increasing. What are you seeing in terms of symptoms and risk factors?
We are seeing quite an increase in individuals complaining of residual symptoms, be they cardiac abnormalities, (heart) rhythm abnormalities, breathing disorders, reduced exercise tolerance, persistent fatigue, brain fog and then a variety of symptoms ranging from neurological symptoms to thyroid dysfunction to gastrointestinal bowel problems.
Initially it was believed that those who are unvaccinated are at higher risk of long COVID. The thought that an asymptomatic illness or a mildly symptomatic illness would not drive you to a long COVID as much as a serious illness. This spectrum has changed.
We see individuals with asymptomatic and mildly symptomatic illnesses. What’s frustrating is that we really can’t offer medication to these patients. It is more of a multidisciplinary approach oriented towards rehabilitation activities to try to manage their symptoms.
The Centers for Disease Control and Prevention reports a slow increase in hospital admissions in New Hampshire. (screenshot)
Even in breakthrough cases, are vaccinations and booster shots the best protection against long COVID?
Although we’ve long seen COVID in vaccinated and boosted people, we don’t yet have enough data to say it’s significantly less compared to those who aren’t vaccinated. But the odds are that’s true. Getting vaccinated and kept up-to-date reduces the likelihood of you getting the infection in the first place, which then reduces the likelihood of all other consequences.
This wave is different in that hospital admissions and deaths remain constant while cases are increasing. Why?
The BA.2 variant (from omicron) dominates the scene. It is more portable than the original Omicron subvariants, likely resulting in increased portability.
I think what you’re also seeing is that more than 50 percent of those who are eligible for a booster shot didn’t get a booster shot. And the waning immunity and partial immunity to reinfection…probably also makes some people more vulnerable than before. And then, more importantly, as the weather improves and masks are removed and things return to normal, human and social interactions increase.
You need to be aware of three things in particular: What is the risk to yourself? What is the level of risk you are exposing others around you to? And what are your community transfer rates?
If you really consciously think about your reaction in relation to these things, you can live your life normally to some extent, even as these (community transfer and level) numbers go up.
But we do know that individuals have not done everything they can to protect themselves from infection.
The Centers for Disease Control and Prevention reports a slight increase in cases and almost no COVID-19 deaths. (screenshot)
They have seen an increase in hospital admissions without COVID-19. How do these relate to more relaxed security habits?
We’ve seen an increase in non-COVID respiratory viruses, which is likely due to masks being taken off and people interacting more. We’ve seen quite a spike in influenza, respiratory syncytial virus, rhinovirus, parainfluenza, and all those other respiratory viruses that plagued us for years before COVID hit the scene. The last two years have been an aberration where we really hadn’t seen any of that.
Antiviral drugs that can reduce the risk of serious illness and hospitalization are no longer in short supply. But access remains limited for other reasons. Why?
What we’ve heard a lot is that people tend to ignore some of their initial symptoms and when they take a COVID-19 test they’re close to five or six days and don’t qualify. Don’t ignore your allergy symptoms as allergies unless you’ve proven you’re not COVID positive.
And the recommendation when using a home test is not to trust a single negative, especially when community rates are rising. You would benefit from repeating an antigen test within 24 to 48 hours. If you have two negatives, you can say with reasonable certainty that it’s probably not COVID
And if there are drug interactions (with a person’s existing medications), you may need to ask them to stop taking those drugs for a period of time. And to qualify, you must be mildly symptomatic. You cannot be asymptomatic and you cannot be symptomatic enough to require supplemental oxygen support
So it’s really not that easy to prescribe someone (medication) and get it over the counter. It’s a little difficult.