The new isolation Guidelines and why this may be the last wave

Well, it’s back. I just finished a week in the ICU and COVID has come back with a vengeance. Our numbers tripled over just a couple weeks, faster than at any other time in the pandemic. We went from having no patients in the ICU to having a third of our ICU patients having COVID-19. Outside the hospital I started getting calls from neighbors and friends with questions about isolation and quarantine and reports from local testing sites of lines out the door around the building. In short, it started to feel more like December 2020 than December 2021. It was déjà vu all over again and, just like every other time, it was exhausting physically and emotionally.

With the rapid rise in Omicron, things started to sound very familiar to prior waves. Everyone was bracing for more restrictive mitigation strategies when the CDC issued a statement 12/27 that seemed out of step with the frightening rise in case numbers. They were more lenient this time.

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Should you vaccinate your kids?

Vaccines for COVID-19 | CDC

It was a rough day that Friday morning. He was a 41-year-old otherwise healthy male who was afraid to get the vaccine because he wanted to “wait and see”. Unfortunately, COVID got him before he had a chance. He came in with pretty severe disease but was holding his own until the week before when he started to deteriorate rapidly. His oxygenation became severely diminished and we had to put him on life support. We were forced to put him in a medically induced coma, paralyzed him, and put him on his stomach. Despite throwing everything we had at him, his oxygenation continued to worsen. Friday morning it was clear that he was not going to make it through the day. This all weighed heavy on the ICU team but it became overwhelming when his 3 teenage children came to see him. We watched as it sunk in that their father was going to die that day. It was his youngest son’s birthday.

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I got my booster, should you?

It is not that I am a masochist, I’m just a bit impulsive. There I was again, in the same conference room I had been two times before back in December and January, lifting up my sleeve to get vaccinated against COVID-19. On one side of the room was a nurse with smiling eyes cheerfully administering my 3rd dose of the Pfizer vaccine just like the previous two times. This time, however, there was another nurse a few tables over willing to give me a flu shot. Why would I want to get both vaccines and a double shot of that crummy post-vaccine feeling? The answer is simple. I need to get them done at work otherwise I have to somehow prove to the HR department that I was vaccinated elsewhere. This involves emailing forms to nameless and faceless mailboxes, hoping there is someone checking at the other end. The pain of dealing with the bureaucracy of a multi-billion dollar healthcare corporation is far greater than the combined pain of both vaccinations. The real question is, was it the right thing for me to get the booster, and should you get yours as well. It turns out this is quite a difficult question to answer.

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Is vaccination better than prior infection?

In my job, ‘I told you so’ is a very unsatisfying experience. We’ve all experienced the spark of schadenfreude when, after a bitter disagreement with another, we are proven right in unassailable terms. It’s a wicked joy, no doubt fueled by some deep-seated insecurity, but it is a joy nonetheless. You would think the opportunities for the elation of ‘I told you so’ abound in medicine. After all, we tell people to do things all the time for their own good and they resist us more often than you would think. Unfortunately, this is not the case.

While suiting up to see my first critically ill COVID patient in several months I felt the schadenfreude brimming when the resident told me he was unvaccinated. I, along with just about every other doctor in the world, have been preaching the merits of vaccination to anyone who will listen. I wrote about it when I got my first dose back in December 2020. I think I made a strong case and that was long before we had several months of data and experience showing better than expected efficacy and safety. So when I went into room 504 there was a small part in the back of my head giddy with the prospects of the ‘I told you so’. Don’t get me wrong. I am not a monster. I wasn’t going to lay it on him right out of the gate. I had a plan for a more subtle drop of sarcasm to get the point across without being too harsh. Not as pleasurable as a pointed finger and playground sing-song but effective nonetheless. Well, that was my plan – until I saw him.

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90 is not 100 and the risk of COVID after vaccination

“Dr. Grove, I got COVID,”  was the first thing she said to me when I returned her call.  She has severe asthma and she was a bit worried.  Fortunately, she did not have severe a case so the first thing she said did not worry me.  It was the second thing she said that worried me.  “I got my vaccine, too”.  My next thought was that she must have contracted her infection between the first and second vaccine doses and, as if she read my mind and before I could ask, she concluded, “And I got my second dose in February.”  Ugh.  This means she got COVID even though she was fully vaccinated.  That wasn’t the only call like this I got last week.

The second call was from someone who wasn’t feeling well.  She called me to ask what she should do since she was exposed to someone who was known to have COVID.  The person she was exposed to was fully vaccinated but had more than one child at home with proven COVID.  She felt sick but assumed that it couldn’t be COVID because she was fully vaccinated.  She didn’t get tested or quarantine and went to the party even though she didn’t feel well.  Unfortunately she was wrong and tested positive a few days later after exposing multiple people. 

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Why the Johnson and Johnson vaccine side effect is so worrisome

She was a 51 year-old lady with asthma so severe that she required regular injections of a special medicine to keep her out of the hospital. She had prolonged damage to her lungs from her disease and daily symptoms of wheezing and shortness of breath. Any insult, whether it be a cold or cut grass, could put her out of commission. So when I asked her if she had her COVID vaccine she surprised me when she said was afraid of the side effects. So, a woman who has a very high likelihood of dying from this virus, was afraid of the vaccine. Her fear was driven by reports of scary side effects, most recently with the Johnson and Johnson vaccine.

Her decision was irrational but predictably so.

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Is the Johnson and Johnson vaccine any good?

How the Johnson & Johnson, Pfizer and Moderna COVID-19 vaccines compare |  ABC27

This post will attempt to answer the following questions:

  1. How do vaccines work?
  2. How does the Johnson & Johnson vaccine work compared to Pfizer and Moderna?
  3. Is it safe?
  4. Is it effective?
  5. Which vaccine should you get?

If a screech of joy could be expressed in text version, this was the sentiment that was given over by my wife’s text after she received her Johnson & Johnson vaccine. Just as everything else with this pandemic, her vaccine experience was annoying, uncertain, and unpredictable. She had heard that the Johnson & Johnson vaccine was available for her eligibility group from a friend and she went searching all over town for a place to get hers. Before embarking on her wild goose chase, she asked me if she should get this shot or wait until an opportunity to get the Pfizer or Moderna vaccines when they are available (and who knows when that will be!?). To be honest, I did not have a clear answer for her as a result of my own ignorance so I got to work doing the research. She decided to get it before I was able to render an opinion but it turns out she made the right choice. I thought I would give you a layman’s explanation of what I discovered and why I think she made the right decision.

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There’s one more surge coming

This post will attempt to answer the following questions:

  1. When is herd immunity expected to be reached?
  2. What impact will the UK variant B.1.1.7 have on us?
  3. Will there be another big surge of cases before the summer?

It was the beginning of December,1944 and, six months after the D-day invasion of Europe. Allied forces had steadily marched East towards Berlin much faster than anyone had expected. The steady flow of newsreels showing allied victories lifted morale back home for those desperate for this long and brutal war to end. Many felt it was pretty much already won. The nation began to relax.

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The best possible news

This post will attempt to answer the following questions:

  1. What is the data that has recently come out of Israel on the effectiveness of the Pfizer vaccine?
  2. How effective is the vaccine in real life?
  3. How effective is it at preventing asymptomatic spread?
  4. What does this mean for COVID restrictions?

It has been a snowy, dreary several weeks here in Baltimore. The days are short, gray, and cold. It has been dark when I go to work and dark when I come home, but it has been even darker in between. The long COVID winter has left a dusky haze over every thought and feeling. This was where my head was when on February 24th, without warning, the sun shone overhead and the temperatures suddenly rose. The bright sunshine reflected on the melting snow and ice. It was as if the world suddenly woke up out of a coma.

The sun warmed me on the outside, but it was the New England Journal of Medicine that warmed me on the inside.

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Will the vaccines work against the new COVID strains?

This post will attempt to answer the following questions:

  1. What are viral variants and what do they do?
  2. What are the SARS CoV2 variants of concern?
  3. What is the difference between the UK and South African variants?
  4. Are the vaccines effective against the new strains?
  5. How do we know?

I was late. It was an early class and it was the furthest distance across campus and I was late for the first day of organic chemistry. The class was notorious for its brutality and I didn’t want to start behind, but behind I was. The auditorium had a few hundred seats and the decor made me feel as if I had traveled back in time 100 years with its wood paneling and musty aroma. The professor was a small woman dwarfed by the 10 oversized chalkboards that spread 30 feet a across and slid up and down like a dust covered guillotine. She had already started scribbling illegible hieroglyphics that I should have been paying attention to but I was more focused on where I was going to sit. There was not an empty seat in the room which was teeming with eager pre-meds with clean, unused notebooks and sharp cornered overpriced textbooks. I ended up sitting on the steps at the top of the aisle.

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