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COVID-19 treatment, vaccines bring hope

Mask, social distancing, diligence still required

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I spent the New Year’s weekend covering for my colleagues at St. Luke Community Healthcare, admitting patients to the hospital. I saw firsthand how we went from a nearly empty COVID-19 unit to filling half the beds. We have a light at the end of the tunnel with the vaccine, but it is still important to wear the mask and social distance. 

January is expected to bring a more significant surge, and some parts of the country are having to prioritize ICU care. We have been fortunate, so far, in Montana, but there is also some data suggesting that, because COVID is using up a lot of resources, care for patients with other emergencies, like heart attacks, strokes and car accidents may be less than optimal.

COVID-19 treatment

New word for the day: bamlanivimab. Although it seems like the perfect word for a Scrabble game, it is actually an emerging and promising treatment for COVID. Bamlanivimab is an antibody infusion that can help prevent some of the most severe respiratory complications of the virus. Right now, it is available for patients who have tested positive for COVID in the preceding three to five days, who don’t need hospital care and: 

—  Are 65 years or older or

—  Have diabetes or

—  Have kidney disease or

—  Have a BMI of 35 (obesity) or

—  Have an immune suppressing condition or

—  Are on immune suppressing drugs.

It is also available for those older than 55 with high blood pressure or diabetes or COPD (asthma or emphysema). There are also indications it can help some kids with chronic illnesses who are older than 12. (Ask your primary care physician for more information.)

The most important thing is to start treatment early to prevent the need for hospitalization, and this means those who think they might have symptoms or have had a worrisome exposure should be tested. Although there is a cost for the infusion, the drug itself is being provided by a federal program with no cost to patients. This is an amazing way to keep yourself out of the hospital. The patients I have prescribed it for reported feeling a little “flu-ish” after getting it, but overall good. The aftermath of a COVID infection (even a mild one) can be long-term shortness of breath; inflammation in your heart, brain, joints; blood clots in your lungs and strokes. We have seen all of these things with local cases.

The vaccine

As we have all heard in the news, there are two vaccines which have gotten Emergency Use Authorization by the U.S. Food and Drug Administration for COVID. One, made by Pfizer/BioNTech, has been distributed to our regional large hospitals. The other, made by Moderna, is being distributed to our local, smaller hospitals and health departments. The state has developed a priority plan for vaccinating those who desire to be vaccinated. It is available at: https://dphhs.mt.gov/Portals/85/Documents/Coronavirus/COVID-19VaccineAllocationPlan.pdf.

Both my medical assistant Vanessa and I were vaccinated at the end of December. I can tell you that I had a mild headache and a mildly sore arm (which did not prevent me from skiing) for two days after the vaccine and absolutely no other side effects. We will get our second shot at the end of January.

The technology for making the vaccine has been around for years and is being investigated as a treatment for cancer. Both vaccines use messenger RNA (ribonucleic acid). There is much misinformation about how this works, but if I had to simplify it, I would say that the vaccine delivers messenger RNA to your cells. It “borrows” the cell’s protein manufacturing plant to create the spike protein which is then presented to the immune system to create an immune response. The next time your immune system sees the spike protein, your immune cells will neutralize it. It does not alter the DNA (the genetic material) of any of your cells. RNA and DNA are two very different things. 

Both vaccines are more than 90 percent effective at keeping you from getting sick with COVID. It is not currently known if they will keep you from becoming a carrier of the virus, so, even after vaccination, we will need to wear masks and wash our hands, so that we are not passing the virus to those people who choose not to be immunized.

Current thinking is that your natural immunity lasts approximately 90 days if you actually get COVID. There have been some reports of people getting COVID twice, more than three months apart. We know that the vaccine offers at least six months of immunity because that is how long we have been using it (it may be more, we just don’t know yet). Like any good primary care physician, I believe that preventing illness is very important. It is important for people’s health and quality of life, but it is also important from an economic standpoint. Our healthcare system was already crippled by the staggering cost of healthcare before COVID and the sheer volume of critically sick patients that the pandemic has brought to us will only make the problem worse. This could lead to higher insurance premium costs and reduced funding for services in federal and state programs. Even if your employer is paying for your insurance, that is money that is not available for raises, bonuses and other job perks. If our community chooses not to get vaccinated, we have to accept that one of the consequences of that will be higher healthcare costs going forward. 

I understand that it may seem like the development of this vaccine was “rushed” without proper study, but the reality is that the studies were done and the safety profile is good. What made the process faster was a reduction in the red tape necessary to get the trials underway, an infusion of money into the development from the federal government and private donors, and a disease that is so common that it didn’t take very long to recruit patients into the studies. Some people will definitely have reactions to the vaccine that may be mild (like mine) or may be more severe (like severe allergic reaction). This is true of any substance we take into our body – food, medicine, chemicals, herbal things and environmental substances (like bee stings). After the vaccine is administered, expect to be observed for at least 15 minutes to make sure you don’t have any of those potentially serious reactions. You will also be invited to provide feedback into a registry the Centers for Disease Control has created called V-safe.

Testing

COVID testing is available at both local hospitals, Tribal Health and at our clinic. Results are generally taking about 48 hours. At St. Luke hospital, testing is available in the drive-through fashion Monday through Friday from 10 a.m. to 6 p.m. and Saturday and Sunday from 10 a.m. to 2 p.m. Providence St. Joseph Medical Center also offers testing via a visit in their urgent care center from 8 a.m. to 7 p.m. every day. Both hospitals can bill your insurance for the test. Some insurances are covering it 100 percent, even if you haven’t met your deductible, but it is always best to call the insurance company directly for clarification. At the risk of sounding like a broken record, you should quarantine at home until your test results are available.

With continued attention to mask and safety protocols and the protection provided by the new vaccines, there is certainly pandemic-hope on the horizon in the New Year. That’s something we can all celebrate.

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