CMO Update June 23, 2022
As Summer officially kicks off and we start preparing for vacation travel I wanted to provide an update on COVID so that we can all try to stay safe during our holidays. There is a fair amount of new information that I urge you to consider. Here is an excellent link regarding the current state of COVID.

Within our QDP team, we are still experiencing a higher-than-normal number of provider and staff absences due to COVID infection. We remain strongly invested in our safety protocols and want to emphasize not to let your guard down. The COVID-19 pandemic is not over, as much as all of us wish that were true! The US is definitely in another rising surge, but COVID fatigue is hampering media coverage and less testing is limiting data collection efforts.

  • The Omicron surge early this year that infected almost 50% of Americans was produced by BA1 variant that affected the nose and throat more than the lungs, producing milder disease, particularly if you had some immunity from vaccination and/or prior infection. 

  • But the newer Omicron BA.2, BA.2.12.1, BA.4, and BA.5 variants have progressively increased immune escape and there is limited cross-immunity with BA.1. They also have more affinity for the lungs and are MUCH more transmissible 

  • So even a recent Omicron infection does not guarantee a “safe period” like we used to think was at least 90 days with earlier variants. I am aware of reinfections occurring within several weeks.

  • Immune-evasive Omicron BA4/BA5 variants are rising rapidly in US (red, dark green, light green bars) and now account for 35% of cases

  • Booster doses increase antibody response to all COVID variants, so adding a booster dose may help decrease both transmission and disease severity even if infected with a new variant

  • But, this increased antibody response is now very time limited, with protection waning to 0% at 5 months for BA1/BA2 and is likely much shorter for BA4/BA5

  • Fall boosters will be needed, although it is not clear that they can keep up with the pace of mutation, so many experts are recommending a renewed government focus on pan-coronavirus vaccine development akin to Operation Warp Speed

  • Just today, Moderna announced that an updated bivalent mRNA vaccine showed increased neutralizing titers against BA.4 and BA.5 Omicron subvariants among all participants (95% CI: 5.0, 5.9). Neutralizing titers increased by 6.3-fold (95% CI: 5.7, 6.9) among specifically seronegative patients. However, the boost to neutralizing titers for BA.4 and BA.5 was not quite as high as the boost in neutralizing titers against the original Omicron variant, BA.1, or the Delta variant. Moderna noted that a peer-reviewed manuscript describing clinical trial data should be available soon.  
I contracted COVID about 6 weeks ago from a social exposure despite taking all precautions. I routinely tested myself prior to work, so became aware of my infection within hours and was completely asymptomatic. I completed an antiviral Paxlovid course without incident, tested negative a week later, and initially was relieved and confident that I was going to be ‘super-immune’ through the summer due to my 4 vaccine doses and a COVID infection. 

  • Despite no early symptoms, 10 days later I developed a chronic cough persisting now for over a month. Even after two steroid tapers, CXR to rule out pneumonia, antibiotics and inhalers I have seen little improvement. I continue to test negative but am battling these annoying symptoms.

  • After reading more about these new variants, I am much less confident of my immunity and will continue to mask with N95 in congested public places, during airline travel, and other high-risk settings to avoid another infection.

  • So why am I so worried about re-infection? Because new evidence shows that each additional infection with the newer variants raises one’s personal risk of bad outcomes in many different organ systems.

  • We need to consider the cumulative and potentially irreversible long-term damage to lungs, heart, brain etc. with more infections, even with mild symptoms that don’t cause hospitalization or death.
There has been a lot of news coverage for the new FDA approval of COVID vaccines for children from 6 months to 5 years. While a long time coming, the vaccine is considered very safe and widely recommended by authoritative sources including The American Academy of Pediatrics. The detailed data is limited regarding the additional benefit of vaccination for a child with known prior infection, but it is still recommended because vaccination increases the antibody levels which is likely protective, even if temporarily. Here is an excellent review of the childhood vaccine including pros and cons.
COVID Testing requirements for both domestic and international airline travel has been waived. Given the current surge of infections, one must assume there will be COVID positive passengers onboard every flight, bus or train ride. I consider any prolonged time in a closed indoor space a high-risk setting, even with the excellent air exchange and filtration in airplane cabins, and would strongly recommend N95/KN95 masking even if not required.

Remember, that you have a lot of control over your own risk and the risk to your family, patients and close contacts . We need to utilize all available behavioral and pharmacologic measures like improved ventilation, distancing, masking with KN95/N95, hand and cough hygiene, antiviral and monoclonal antibody medications and vaccines/boosters. Enjoy the outdoors and the company of close friends and family who you know are also being cautious. But take precautions at the mall, movies, sporting events and concerts where risks are high for exposure and I would still avoid crowded and noisy restaurants and bars where aerosolized coronavirus is most certainly circulating in the air.

I hope everyone enjoys a safe, healthy and relaxing summer and that during our July 4th picnics and gatherings we remember the importance of our country’s independence and American virtues, like e puribus unum, latin for “out of many, one”. The United States was built by bringing diverse people together from all walks of life, all nations, all religions. There is much more uniting us all than dividing us. This a message that resonates within our own families, our work teams, our neighborhoods and even among strangers and foreigners. I know our QualDerm leadership team appreciates the many talents and contributions you all make to create a company greater than the sum of its parts. 
Dr. A
Questions or Comments?
Please send any questions or comments to the QDP Health Information inbox: health@qualderm.com