CMO Update March 29, 2022 It has been several weeks since our last update and many of us have enjoyed some spring break travels and a glimpse of pre-COVID normalcy in daily life. I mentioned previously that the Omicron BA.2 variant was something to watch. It has now become clear that numerous European countries have seen surges of COVID infection with BA.2, which is about 30-40% more transmissible than the original Omicron variant.

And it is not just infections, hospitalizations are also rising. It remains unknown if BA.2 causes more serious illness, but more countries are seeing an uptick in COVID admissions.

We do know that what happens in the UK and Europe has also happened here in 5 out of 5 prior COVID surges. Plus, most masking and distancing mandates have been lifted and people are enjoying newfound freedoms and a normalcy of life, the exact conditions favorable to a highly transmissible BA.2 variant. So, it is not surprising to see we are starting to experience a 6th wave with scattered hot spots. But how big a wave is still unknown.

While vaccination and booster rates remain lower in the US than other countries, we do have significant but unknown natural immunity. Plus, we are starting from a very low case burden, unlike previous waves and personal immunity should hopefully prevent cases from becoming hospitalizations and deaths. Many experts are optimistic that this surge will have a minor impact overall, with some clusters of local intensity where herd immunity is low.

For those with no vaccine or natural immunity, BA.2 can still become a serious problem and these people are much more likely to become infected and die. Notice the small increase in deaths early this year, likely due to waning immunity from prior vaccination or infection. The primary risk now is for the elderly, immunocompromised and those with other medical conditions predisposing them to worse outcomes.

In order to reduce this risk, the FDA is expected to authorize 2nd boosters of mRNA coronavirus vaccine (Pfizer and Moderna) for all people age 50 and older. This comes in response to evidence that immunity, especially from vaccines, wanes after 4-6 months and because BA.2 is so highly contagious. Additional booster doses enhance one’s antibody response and is recommended for anyone at risk or frequently in contact with higher risk individuals, like close family or friends. It may also be recommended this fall to prevent another winter surge, unless a pan-coronavirus vaccine is successfully developed that would be a universal vaccination with much longer effectiveness. Several studies show that Long COVID symptoms are significantly lower for the vaccinated compared to those with only natural immunity from prior infection. Akiko Iwasaki, a viral immunologist at the Yale, states “Long COVID is a terrible and debilitating disease. Any measures we can take to prevent long COVID are key to limiting more suffering in the future. One more reason to get vaccinated.” Given the very contagious BA.2 variant and our loosened preventive measures, I would expect most of us to be exposed to the coronavirus in the future. Vaccinated immunity seems to help prevent an acute minor illness from becoming a long-term problem. The other COVID good news is that the majority of therapies including antivirals and monoclonal antibodies are expected to remain effective against the BA.2 subvariant. One antibody therapy sotrovimab is being pulled since it is unlikely to be effective until manufacturers increase it to a higher dose formulation. Regarding QualDerm practices, we are continuing to be diligent in our safety precautions to protect our vulnerable patients and teammates. Symptom screening, universal masking, hand/cough hygiene and thorough cleaning protocols remain fully in effect. But regional market leadership may evaluate community transmissions, hospital case load and local standards to determine when the risk is low enough to relax the one-visitor policy and physical distancing in waiting areas. Finally, I attended the American Academy of Dermatology Annual Meeting this past weekend in Boston and was very gratified to hear so many positive comments and favorable impressions of our QualDerm company from fellow dermatologists. We continue to forge a reputation for the highest quality of providers and practice support teams and are respected for our shared belief in integrity, quality, safety and true partnership. I am thankful for all you do to elevate QualDerm as the premier group with whom dermatologists want to both join and stay. Have a great week! Dr. A

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