Summer Plans, Covid, and the 4th of July

Taking stock of BA.4 and BA.5, and why the number of times we get Covid matters.

This update from a primary care doc perspective is going to be more anecdotal and less scientifically footnoted. I worked 14 hours yesterday, so I’ll keep this more conversational. Plus, the surveillance data undergirding the world’s pandemic strategy is getting increasingly hard to collect. People aren’t testing as much, and many have become too fatigued for old precautions. I will say that I’m still seeing a very steady churn of Covid cases - young people, healthy people, vaccinated and boosted people, and of course the more vulnerable population.

I’m curious what my readers are doing to protect themselves. Which hypothetical person matches your stance most closely? Of course there are little details that will overlap, and behaviors are not 100% consistent every day!

• Person A is up to date with vaccinations and booster(s). They avoid crowded indoor places, or wear a good quality mask when inside places like stores. They limit socialization inside, and mostly stay outdoors with friends and family.

• Person B has received at least the primary vaccine series +/- a booster. They have been eating inside restaurants, shopping without a mask, and entertaining friends and family with occasions like dinners inside and sleepovers for the kids.

• Person C is unvaccinated or not fully vaccinated, and has no interest in wearing a mask. Their behavior only changes when they feel sick, in which case they test and/or stay home when sick.

I’m sure there are a lot of people with mild Covid who are not calling in or doing video visits. But here’s what I am seeing over the past month. There is a lot of Covid out there. The BA.5 variant is taking over. It is extremely contagious, and easily breaks through the antibodies we have accumulated through vaccination, boosters, and prior infection. People infected during the Omicron wave are getting reinfected. People with 3 and 4 total vaccinations are getting infected. A lot of them are telling me they feel quite terrible: fevers, profound fatigue and aches, more coughing and lung problems that do not clear up easily, and impaired thinking.

We have sent a few to the hospital, but for the most part people are recovering at home. I am writing 5-10 prescriptions for Paxlovid a day, and sometimes coordinating infusions for those who cannot take the easier pills.

There is a new study out of the VA system showing that each time we get Covid, the risk of longer term complications increases. There is a higher risk of dying from all causes in the first 6 months after getting Covid the first time. A second round with Covid doubles this mortality risk again. In terms of absolute numbers, this would mean that an extra 23 out of 1,000 people die in the first 6 month after getting Covid for the second time. This is like a boxer getting repeated body blows.