Q&A: COVID Update
Dr. Dan Fulton, McFarland Clinic infectious disease specialist, provides an update on COVID, including advice on vaccines.
What is the status of COVID right now?
COVID-19 continues to circulate, and here in Iowa it seems to be following the late summer/early fall increase in circulation followed by a more seasonal winter circulation pattern. We continue to see the emergence of new variants, although the changes in the virus are not as large as they were. From a practical standpoint, this means that our immune systems still recognize COVID-19 based on our prior exposure either through vaccine or infection, and thus we remain largely protected from severe illness. People with high-risk health conditions such as those with heart and lung illnesses, the immunocompromised, and the elderly remain at risk for more severe illness. We continue to see these at-risk populations requiring hospitalization, although at a much lower rate than we saw at the pandemic’s height. At-risk patients should stay up to date with their vaccines to decrease the chance of getting severely ill.
Are there concerns about people getting comfortable with the idea of COVID (like it’s the new normal)?
Yes and no. Those at risk especially need to maintain a higher level of vigilance to avoid infection. On the other hand, it’s important to recognize that for the general population COVID-19 is becoming a part of our seasonal virus panel. People should be thoughtful about avoiding others when they are sick, but we are beyond the days of everyone needing to wear a mask and social distance. There are many non-COVID viruses that can also make people sick (e.g., influenza). At this point we are moving beyond needing to single out COVID-19 to such a high degree.
Are we still seeing the severity of cases in people who have been hospitalized?
Yes and no. Most people hospitalized now with COVID-19 also have other conditions that the infection can exacerbate. If a patient has heart or lung disease on the edge of decompensating, COVID-19 can be the final straw. In the early days of COVID-19, we saw so many people with no other health conditions coming in with lung damage resulting directly from COVID, but now that is very rare.
What is the thinking about vaccines? Should people be getting boosters?
COVID-19 vaccines are safe, effective, and recommended for everyone >6 months old for the MRN vaccines and >12 years old for the Novavax Vaccine. The reality, though, is that we know many people are no longer staying up to date with these vaccines. For that reason, the CDC makes a strong recommendation for people who have risk factors to consider getting vaccinated. For my part, I continue to get vaccinated because the vaccines are associated with a decreased risk of developing long COVID. I also view having a COVID-19 infection as essentially equivalent to getting a vaccine. So, if people already had their late summer/early fall bout of COVID, they are probably good to go for the year unless they have risk factors for severe disease, in which case after a couple of months they should get their booster.
You were on the frontlines, at least locally, during the height of the pandemic. What lessons do you think we learned?
I think we learned how resilient our healthcare system is. Despite incredibly challenging conditions, our healthcare teams, especially here at MGMC, continued to show up every day and provide extraordinary care. Even now, I hear people reminiscing about some of the hardest times we saw. There was a real sense of togetherness that developed on the front lines, and I think we will carry that collectively for the long term. I also think we learned how important it is to be a trusted source of reliable healthcare information. Unfortunately, these days misinformation is just a few clicks away and it is so important for patients, families, and communities to have a known, reliable, and accountable source of information when it comes to their healthcare. We need to keep these lines of communication wide open so that next time a public health crisis emerges, people know exactly where to go for information.
It seems like viruses are always in the news. Are there new ones we should be worrying about?
We monitor for emerging viruses like Mpox and increased circulation of known viruses like Ebola. What really catches my attention, though, is when we see increased rates of vaccine-preventable illness like measles, pertussis, and influenza. One unfortunate aspect of the misinformation that came out around COVID-19 vaccines is that we saw decreased uptake of all vaccines, which has allowed for a reemergence of these preventable illnesses. These vaccines have a long track record of safety and effectiveness, and I strongly encourage people to keep themselves and their children on schedule. On the positive side, all of our work to prevent COVID-19 spread over the past few years seems to have had an unintended effect—one of the previously circulating influenza B strains appears to have gone extinct. Flu shots this year cover three instead of four strains of influenza because one of the influenza B strains couldn’t survive all those masks and social distancing.
