March 2024 in Covidlandia
New studies and reports of interest to primary care. Curated with commentary.
I still live in Covidlandia. It’s a parallel world where people acknowledge that Covid is still with us, that there is much we don’t know but keep discovering, and that it’s worth trying to reasonably protect ourselves from this coronavirus. A little extra caution, testing when symptomatic, and early treatment all help.
Covidlandia is not filled with fear, but rather a clear eyed recognition that this novel virus has changed the game, and we would be wise to keep adapting and evolving along with it. To that end I present the third monthly installment of key articles, trials, and research that caught my attention as a family doctor. January and February were popular posts. Of course it’s all too much for any one clinician to keep up with… but here is a collection of useful highlights, curated and presented succinctly with sources for those who want a deeper dive.
Covid was still a thing in March, and new CDC guidelines abandoning reasonable sick precautions upset many.
I agree with this opinion written by Dr. Julia Vogel in early March in which she states:
In recent weeks, there have been an average of 2,000 deaths and 20,000 hospitalizations per week. The CDC just released the first data on the prevalence of long Covid in 2024, showing that 6.8% of U.S. adults are currently experiencing long Covid (up over a percent from the prior data collected last October), including after reinfections and among people who have been vaccinated…
By allowing known Covid-positive people to resume normal life, we shift the burden of Covid prevention to those who are at the highest risk… Instead, our governments should focus on low-effort ways to reduce Covid spread, such as setting standards for clean indoor air, testing to leave isolation (using freely available rapid antigen tests), offering high-quality masks and recommending them in public indoor settings, and mandating paid sick leave. We should improve public health communication about the risks of long Covid, long-term health impacts of Covid infection, and the ongoing risks of certain populations. Our policies should adapt to the current research and technology.
Maybe you don’t see the long Covid burden in your every day life, but as a primary care doctor I do see that 6.8% and more. Especially if we look for it, while ruling out other causes of profound fatigue, post-exertional malaise, shortness of breath, and cognitive problems in several 30 year-olds just this week for goodness sake.
Similar long Covid rates (~8%) were seen in a study out of France. Encouragingly, the prevalence dropped to 2.4% when the long Covid definition required at least moderate impact on daily activities, and dropped further to 1.2% when the definition was strong or very strong impact of symptoms on daily activities.
Spring boosters
The CDC recommends that people aged 65 years and older should receive 1 additional dose this spring (now) of the updated COVID-19 vaccine at least 4 months after the previous updated dose.
I’ve started doing this in the office, and the power of the word “should” cannot be denied. It works better than “may” in examining rooms.
And when I share that the updated shot worked 50-70% of the time for people this winter, many formerly hesitant folks hop on the band wagon for their first updated XBB dose.
Immunocompromised people may get another dose, too, and many experts recommend getting a boost every 6 months.
A guy received up to 217 Covid vaccinations
This was stunning, and chances are you’ve already heard about it. Reported in The Lancet Infectious Diseases, this erratic 62 year-old individual did afford researchers a rare chance to see what happens when the immune system is bombarded repeatedly with Covid vaccines:
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