By Dr. Tim Dombrowski, DO, MPH
Editor’s Note: The South Jersey Catholic Medical Guild of the Diocese of Camden is a Catholic organization of men and women in healthcare. Its purpose is to uphold the principles of the Catholic faith and morality as related to the science of medicine.
The COVID-19 pandemic started in South Jersey in March 2020. Testing results at that time took days before they were available and sometimes would be negative in patients with symptoms and positive in patients without symptoms. To complicate the situation, there were no known treatments or vaccines to prevent the illness. The illness is called COVID-19, and it is caused by the virus, SARS CoV-2. The measures that were promoted during the early days of COVID-19 before antibiotics and vaccines and are still important to prevent the spread of this infection are public health measures, such as masks, social distancing and hand washing.
We have survived during this pandemic to see the release of the Pfizer and Moderna COVID vaccines in December 2020 and the Johnson & Johnson vaccine shortly afterward. The pandemic was characterized by a series of mutations in the SARS CoV-2 virus. First the Alpha COVID variant between January and June 2021, then the Delta Surge from May to December 2021, accounting for 90% to 99% of the total amount of the virus in the United States during the months of July, August, September, October and November 2021 and causing a considerable amount of sickness and death before being totally replaced by Omicron in December 2021.
Omicron has been the major variant in the United States since last December and has been characterized by a series of mutations that resulted in seven Omicron subvariants. The mutations in each of the subvariants caused changes in the spike proteins on the surface of the virus. Each Omicron subvariant is more transmissible than its predecessor, which means that it is more likely to spread than the preceding Omicron subvariant. The Omicron variant, although more transmissible, fortunately does not cause as much severe disease and death as the Delta variant did last summer and fall.
What can we expect of the COVID-19 variants in the future? The viruses constantly change through mutation, and sometimes these mutations result in a new variant. Some of these variants emerge, then disappear while other variants emerge and persist. Nevertheless, new variants will continue to emerge. The Centers for Disease Control and Prevention and other organizations monitor all of the variants that cause COVID-19 in the United States and globally to search for Variants of Concern.
The vaccines, masks and testing work to keep people safe. The vaccines reduce the risk of severe illness, hospitalizations and death from COVID-19. Masks should be worn if you (1) are in areas with a high COVID-19 community level, (2) are sick and need to care for others or you are well and caring for someone who is COVID positive, and (3) are at increased risk for severe illness or live with someone at increased risk for severe illness.
Testing with a “viral” test tells you if you have a COVID-19 infection at the time of the test. Examples are (1) the antigen or rapid test and (2) the Nucleic Acid Amplification Test (NAATs) or PCR test, which is a more sensitive test than the antigen test for detecting the presence of the virus. In order to determine which variant caused an infection, additional testing is required, but these tests typically are not authorized for public use.
There are three types of vaccinations available for COVID-19: Moderna, Pfizer and Johnson & Johnson. Remember that getting vaccinated reduces your risk of severe illness, hospitalization and death from COVID-19. The CDC recommends that everyone eligible get vaccinated with the Pfizer or Moderna primary series of two vaccinations and a booster vaccination or an initial J&J vaccination and a booster vaccination of J&J, Pfizer or Moderna.
One treatment for high-risk, non-hospitalized patients with mild to moderate COVID-19 is Paxlovid, which is an oral medication, taken twice daily for five days. It must be started ≤ five days from the onset of symptoms. It has many drug interactions and needs to be reduced in patients with kidney disease and is not recommended in patients with severe hepatic impairment. There is also a condition called COVID-19 Rebound After Paxlovid Treatment, which occurs two-eight days after the initial recovery with Paxlovid treatment and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative.
An alternative treatment for high-risk, non-hospitalized patients with mild to moderate COVID-19 is a monoclonal antibody call Bebtelovimab, which is an intravenous infusion, taken once. It must be started ≤ seven days from the onset of symptoms. It is given over 1 hour and requires the patient to remain for an additional hour after the infusion to be sure there is no reaction to the monoclonal antibody.
There are additional treatments for hospitalized patients, but they are not within the scope of this article. Please go to our website at sjcathmed.org to learn more.
Dr. Tim Dombrowski, DO, MPH, is on the board of directors for the South Jersey Catholic Medical Guild of the Diocese of Camden.
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