I hope you’re doing well and staying safe during this fourth COVID wave, attributable to the omicron variant. The virus is not typed on any regular basis, but with random testing omicron accounts for 95-100% of COVID infections in Maryland, and is probably above 90% nationwide.
The virus is expected to continue to mutate, but the population will have some level of virus recognition as time goes on. As well, there will be additional vaccines, testing protocols and therapies to decrease hospitalizations and deaths.
The bad news about this wave is that it’s spreading like wildfire, and the hospitals are overwhelmed. Governor Hogan has declared a state of emergency in Maryland and has arranged for 1,000 members of the National Guard to assist here. The good news is that percentage-wise the risk of serious illness and death is relatively low, but we’re still losing over 1,200 Americans daily to this illness. The vast majority of people with critical illness are the unvaccinated or under-vaccinated.
Natural infection should render about 90 days of increased immunity, while the primary series of vaccines does well until about six months out. Current recommendations for boosters for the average risk population are: Pfizer – five months after the second dose for 16 years and older; Moderna – six months after the second dose for 18 years and older, and J&J – either full dose Pfizer or half-dose Moderna two months after the first vaccine. A third pediatric dose is allowed for certain 5-11 year olds with immune compromise. A booster for 12-15 year olds is being reviewed by the ACIP.
The booster significantly increases your ability to keep an omicron infection at a mild to moderate level. I CANNOT STRESS ENOUGH HOW IMPORTANT IT IS TO GET A BOOSTER AND ENCOURAGE EVERYONE AROUND YOU TO DO THE SAME. If you need information about vaccines and their availability, please visit
People who have had a covid infection can receive a vaccine (primary or booster) that they’re due for after their quarantine period is over; or at least 90 days after receiving monoclonal antibody treatment.
All of the following therapeutics require a positive test of any kind, and should be started as soon as possible after symptoms, and preferably before three to five days.
We have one monoclonal antibody, sotrovimab, which is effective against the omicron variant. Since the two other monoclonals, which were effective against delta, are not helpful for omicron, they will not be used for now. Therefore, monoclonals are in short supply and will only be available for those who test positive and are at the highest risk of severe illness. They are no longer being used for prophylaxis after exposure as they once were.
There are two oral agents that recently received an EUA from the FDA, paxlovid and molnupiravir. These are in the process of ramping up production and will be more readily available as time goes on. For now, they also will be reserved for the most vulnerable. There are differences between them in terms of efficacy, drug interactions, use in pregnancy and dosage adjustments for kidney problems. If you are in need of one of these treatments, the availability will be part of the decision-making process about which one you will get. The state is working with Walgreens to distribute the doses across Maryland. Your physician should be able to check if and where it is available before ordering it to avoid unnecessary delay. As of today, there are none available in Montgomery County. There is no cost to the patient for the medication except for possibly a delivery fee if you need it to be delivered.
Remdesivir is an intravenous anti-viral that up until now was only used in hospitalized patients. Now it can be used off-label for outpatients 12 years and older, but it requires daily intravenous dosing for three days in a row. It has been shown to be as effective as the others listed, and since it was already in use, the supply is reasonable. Logistics of administering it are being worked out.
Finally, Evusheld is an infusion given at six month intervals to only the moderately to severely immunocompromised and those unable to take the vaccine. It is in very limited supply and only available through hospital systems.
Overall, it’s crucial to get the vaccines including any booster that you are eligible for, and to mask, distance, stay outdoors when feasible, and avoid crowds. The new guidelines regarding quarantine and isolation after a COVID exposure, https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html, are confusing, both because they differ significantly from prior recommendations and because there are many caveats. One part of the recommendation is that if you are vaccinated, boosted and asymptomatic, then you don’t need to quarantine after an exposure to someone with COVID, but should wear a mask around others and test yourself at five days. I don’t necessarily agree with that unless you’re an essential worker. I think you should let others know that you were recently exposed to COVID before seeing them, as you would expect others to do if the roles were reversed. You can check the link above to search for instruction regarding your particular situation.
The pandemic will fade into a manageable status. Let’s all try to stay healthy until that happens. I encourage you to stay involved in activities that warm your heart – art, music, dance, nature, meditation, exercise… We need to nurture our creative selves and take care of our emotional as well as our physical health. Consider checking out Kristen Neff’s Self Compassion site and find out what ‘fierce’ self compassion is! Let me know what brings you joy after two years of twisting and turning through this pandemic maze.
That’s it for now!
We’ll talk soon – Take care.
Marsha Seidelman, M.D.