By Dr. Vivek Sinha
Two years and five months ago in December 2019 was when the world started hearing news reports of COVID19. A lot has happened since then. We have learned from experience and new information continues to emerge on a seemingly daily basis. Vaccines, masks and medications for treatment – all this information can be overwhelming and, occasionally, seemingly contradictory. Let’s see if we can unpack and highlight some of the more important topics.
Currently we have three vaccines that have either Federal Drug Administration approval or Emergency Use Authorization for use against COVID-19. The vaccine schedules and booster recommendations for each of the three vaccines currently available are as follows:
Pfizer: For children ages 5 to 11, the initial series consists of two pediatric doses given three weeks apart. At this time, booster doses are not authorized in this age range.
For people 12 to 50 years of age and older than 50 years, the initial series consists of two adult doses given three weeks apart. A single booster dose is authorized to be given five months following the initial series. A second booster dose is authorized for those older than 50 and only authorized for people between 12 and 50 with moderate to severe immunocompromising conditions. The second booster should be given four months after the first booster.
Moderna: For people 18 to 50 years of age and those older than 50, the initial series consists of two doses given four weeks apart. A single booster dose is authorized to be given five months following the initial series for those between 18 and 50. A second booster dose is only authorized for people in this age range with moderate to severe immunocompromising conditions. A second booster can be administered to everyone 50 years of age or older four months following the first booster.
Note that for both Pfizer and Moderna, a fourth dose may be added to the initial series for certain people with immunocompromising conditions. Please be sure to speak to your physician to see if this would apply to you.
Janssen/Johnson & Johnson: For people 18 years of age and older, the initial series consists of one dose. A single booster dose is authorized to be given two months after the initial series. A second booster of either the Pfizer or Moderna vaccine may be given to people who have received the Janssen/Johnsons & Johnson vaccine for their initial series and first booster.
The benefits of all three vaccines cannot be discounted. Millions of people have received them and while there are risks with any medical treatment, their risk is far outweighed by their benefits. They have changed the face of the pandemic and are one of the biggest reasons why life is starting to slowly return to normal.
Masking guidance continues to be fluid. At this time, the Centers for Disease Control and Prevention has started utilizing a system that measures various metrics, i.e. hospital beds being used, hospital admissions and total number of new COVID-19 cases per 100,000 people in the area in the previous week, to stratify risk. Using this data, the CDC is classifying each individual county as a low risk, medium risk or high-risk county.
The current guidance is that those in a low-risk area may wear a mask based on personal preference or personal level of risk. Those in a medium risk area who are immunocompromised should speak to their physician about best practices and consider wearing a mask. If a person has regular contact with someone who is immunocompromised, that person should consider masking as well. Those in a high-risk area should wear a well-fitting mask in indoor public settings.
It is important to note that masking recommendations are in addition to, not in lieu of, being fully vaccinated and up to date on your booster vaccines.
In the past few months, there have been tremendous advancements in effective treatments for COVID-19. One of the first treatments that was deemed effective against COVID-19 was a class of medications known as monoclonal antibody infusions.
Monoclonal antibodies are laboratory synthesized proteins that act like the person’s immune system’s ability to attack the COVID-19 virus. These medications are intravenous medications that are usually administered in a hospital setting. They are often used in conjunction with other medications, such as steroids and oxygen, to protect the patient from secondary infections.
For people that have tested positive for COVID-19 and have symptoms but are not sick enough to be hospitalized, there are also now two oral medications that can be prescribed to be taken at home: paxlovid or molnupiravir. Either can be prescribed by a physician and can be taken by the patient while he or she is completing quarantine at home. They are pills that are taken orally, usually twice a day for five days.
It is important to note that despite how well the new COVID-19 treatments are working, they are best utilized with a layered approach. For instance, if someone is fully vaccinated and up to date on their booster, they can still catch COVID-19, although their symptoms should be less severe.
If they have mild symptoms, then being treated with one of the outpatient oral medication options and appropriately completing a quarantine should allow them to recover faster than if they weren’t vaccinated. This layered approach is important because it offers the best chance of protection, prevention and recovery if one were to catch COVID-19. So, as the weather gets warmer, get outside and get informed about how you can continue to protect yourself from COVID-19!
The writer is chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.