Welcome to the December newsletter. This newsletter aims to provide information and analysis of timely topics from recent articles published in the medical literature. I hope you find this information useful and helpful in your health journey. If you have comments or questions, please let us know!
We wish you and your families a Happy and Prosperous New Year!
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The Omicron variant, first described in South Africa is now the dominant variant here in Wisconsin making up 67% of cases currently according to the Wisconsin State Laboratory of Hygiene. The good news is that although it is highly transmissible, it continues to appear to be causing fewer severe outcomes. Hopefully, it continues to displace Delta. The onset of symptoms is faster and the period of contagiousness appears to be reduced, which has led the CDC to reduce isolation times for infected individuals. It also does not seem to have the pulmonary affinity (1/10) that Delta had. Vaccines and previous infections continue to be quite beneficial in the prevention of severe outcomes but many more vaccinated and even boosted people are contracting this variant. What I have been seeing in my practice is a lot of typical cold symptoms (nasal congestion, mild cough, low-grade fever, fatigue, headaches) lasting 3-5 days. It's hard to predict what direction things will go from here but this could be a big step toward COVID-19 becoming another seasonal virus that circulates, similar to the other 4 commonly circulating coronaviruses. The combination of vaccination immunity with acquired immunity from a mild infection should provide excellent protection from severe outcomes for most people. At some point, we will likely reacquire a COVID infection, but we may not know the difference between this and any other cold virus (unless we are testing for it). Our memory B cells are able to produce high levels of antibodies if we see it again and these memory B cells will produce antibodies adapted against any variants! Memory B cells are like blueprints for making antibodies but can be modified on the fly. Additionally, as I mentioned previously, exposure to the virus generated T-cell memory even without a detectable viral infection.
At this time I am not recommending booster doses for people who have normal immune systems and previously had the virus. As we move forward, the combination of vaccination, previous infection, and hybrid immunity will continue to lower the number of people susceptible to severe outcomes. This advice could change if a particularly virulent variant would develop.
I am getting a lot of questions about vaccinating teens and children.
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For people who are vaccinating their children, I would recommend waiting longer than recommended between doses (6-12 weeks rather than 3 weeks) as this could boost antibody responses after the second inoculation more than threefold (shown in those older than 80, so children would likely have an even more robust response).
- If a child has had the infection, I don't think a vaccine is necessary unless there are other compelling reasons.
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I am not recommending boosters in teens unless there is a compelling reason (frail or immunocompromised person in the household). They are already at extremely low risk of severe outcomes (a study out of Israel showed the risk of death to be 0) and I am concerned about the process that was undertaken to recommend boosters, which has generated controversy. In my mind, an intervention has to show a clear benefit to the individual to recommend it. While initial vaccination meets this standard for previously uninfected teens, boosters for teens do not.
- I will change recommendations if further information comes out.
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I am happy to announce that I have one of the newest diagnostic tests available. The Galleri test is a blood test that can detect over 50 types of cancer before they are apparent through regular screening testing (and many cancers don't have a screening test). The test detects methylation patterns of cell-free DNA which can indicate cancer and thus has the potential to detect cancers at the earliest stages. If you are interested in learning more about this test please let us know. I'm constantly on the lookout for cutting-edge tests and procedures for my patients and I have a few more things on the horizon that I am evaluating.
