COVID-19 Update

It is hard to imagine that it’s been six and a half years since the COVID-19 pandemic began. It was traumatic for young and old (and those in-between). It was responsible for over seven million deaths worldwide, including more than one million deaths in the United States alone.

The disease, vaccines and treatment have changed substantially over time. The virus is constantly producing new variants, medications have been developed for both prevention and treatment, and effective vaccines continue to be modified for the changing virus.

The good news is that COVID-19 is no longer one of the top ten causes of death. The severity of the virus has declined dramatically. Those over 65 account for 70% of COVID-related hospitalizations, but note that only 11% of Californians are currently vaccinated for COVID, and almost all who are hospitalized are not currently vaccinated!

All major medical societies recommend a yearly vaccine for everyone over 18, including pregnant women, and many recommend the vaccine starting at the age of six months. What about the side effects of the COVID vaccine?

• Typical side effects, as is true for most vaccines, include arm soreness, headache, fatigue, muscle and joint pain, nausea, and fever or chills. These side effects are brief and almost always mild, and are a sign that the body is building protection.

• Anaphylaxis is an extremely rare allergic reaction, occurring in about five in one million doses. It shows itself in the first 15 minutes, which is why we are asked to wait after being vaccinated. For those five in a million, an epinephrine injection is then administered.

• Researchers are monitoring very rare reports of myocarditis and pericarditis in adolescents and young adults. Note that there is a higher incidence of myocarditis and pericarditis in people who get COVID than in those who simply receive the vaccine.

• Rare cases of Guillain-Barre Syndrome were seen only from Johnson & Johnson’s version of the vaccine, which is no longer available.

New research indicates that those who have been infected with COVID have an added risk for heart attack and stroke for approximately three years. Interestingly, those whose blood type is anything other than O are twice as likely to experience an adverse heart event after a COVID-19 infection. This is a good reminder that getting the disease can negatively affect other body organs in addition to the respiratory tract.

How do we become infected? This hasn’t changed: it usually occurs when we are close enough to a sick person to have viral particles enter our eyes, nose or mouth, typically from their cough or sneeze. It is possible for aerosolized particles of the virus to remain suspended in the air and to travel. Some of us are at higher risk for severe illness, leading to hospitalization. This includes older adults and those with underlying illnesses like cancer, chronic kidney disease, chronic lung disease, diabetes, dementia, underlying heart disease, liver disease, obesity, and underlying mental health conditions. In addition, current or former smokers; those with a history of stroke, substance abuse, or tuberculosis; and those who are pregnant all risk experiencing a more severe case.

The symptoms of COVID-19 include fever and chills, cough, shortness of breath, fatigue, muscle aches, headache, loss of taste and smell, sore throat, congestion or runny nose, nausea and vomiting, and diarrhea. If you experience these symptoms, it is easy to test at home. COVID tests are no longer free, and a two-pack costs between $15-$25. Treatment can also be handled at home, including taking Paxlovid, a very effective oral antiviral medication. Other effective antiviral medications are available, including a pre-exposure preventive medication and a medication used after exposure to help prevent infection. A “Z-pack” and other antibiotics have no effect on COVID-19, which is why testing yourself before starting on any medication is critical.

The CDC recommends staying home until overall symptoms are improved for at least 24 hours. For five additional days, protect others by taking extra precautions: wear a mask, wash hands more frequently, and avoid crowds, especially indoors.

Many patients suffer with lingering symptoms for weeks or months after infection, even if the initial infection was mild or asymptomatic. This is known as long COVID, and perhaps one in six of those with COVID-19 develop long COVID. While some major hospitals and medical centers have set up clinics for this, treatments and cures remain mostly elusive.

COVID-19 and long COVID remain with us. Though not as severe as they were, prevention is important. First and foremost, I urge vaccinations for everyone over six months of age. Wear a high-quality face mask in public indoor settings, avoid crowds and poorly ventilated spaces, and wash hands often. Care for yourself through your health habits: It never hurts to work on improving diet, exercise, sleep habits, and stress reduction.