Now that state and federal officials have declared the COVID-19 public health emergency is over, we checked in with some top doctors in Colorado who’ve dealt with the virus first-hand over the last three years and asked them for the most current thinking about the virus: vaccination recommendations, predictions about future spread, long COVID and masking.
Our panel of experts includes Dr. Diane Janowicz, who specializes in infectious disease at St. Mary's Medical Center in Grand Junction; Dr. Anuj Mehta, an ICU pulmonologist at Denver Health who has advised the state on vaccine allocation; and Dr. Ken Lyn-Kew, a critical care pulmonologist at National Jewish Health in Denver.
Answers have been edited slightly for clarity.
Have we moved from a pandemic to the endemic stage of the virus?
Dr. Diane Janowicz: “We're approaching that. Endemic means that we have the disease at a consistent rate, there aren’t drastic increases in infections or outbreaks, and we see a consistent level of people who are infected and spreading the disease in a very predictable manner. But, we're still seeing large numbers of people who are infected on a daily basis. And we're not sure how this disease is going to play out over the next several months, particularly approaching the fall where we expect numbers to increase as we've seen in the past three years. So we’re not there yet, but hopefully soon.”
Can we expect the virus to continue to mutate in the future?
Dr. Diane Janowicz: “We are still seeing different mutations, but whether or not those are going to be as infectious or as severe as we initially saw, it doesn't appear that that's going to be the case, but there is still some unpredictability.”
Can we finally begin to let our guards down?
Dr. Ken Lyn-Kew: “I think that it's too early to completely let our guard down, but we want to continue to learn how to live with this virus and you never want to let your guard down against anything, right? Whether it's influenza, coronavirus or what. And it's here to stay; we just don't know how it's going to stay so we want to make sure that for each individual person, we're taking the right precautions for us. If you're 90 and have immunosuppressive disease, your precautions are going to be different than if you're 25 and completely healthy.
Do I need another vaccine or booster?
Dr. Anuj Mehta: “The Centers for Disease Control has tried to simplify it for most adults, so they have phased out the original, first generation of COVID vaccines called monovalent vaccines. Now we're left with just the new bivalent vaccines and for most adults, a single booster after the original series should be sufficient. But, if you're 65 and over, or if you're immunocompromised, you're eligible to get a second booster.
And remember, the original vaccines against the original virus were very effective at preventing infection. If you're vaccinated now, you may get infected, but they're still very good at preventing you from landing in the hospital and ending up in the ICU. And there's emerging data that being vaccinated will also potentially reduce the risks of long COVID.”
Can we expect to have annual vaccinations against COVID?
Dr. Diane Janowicz: “I think this may mimic what we see with influenza, particularly once we get to an endemic phase of this disease. Whether it's going to be an annual or biannual vaccine, that's going to play out over the next several months until the end of the year.”
What’s the latest research on vaccines?
Dr. Anuj Mehta: “There's always testing being done. Novavax was one that was more recently authorized by the FDA and it didn't gain a lot of traction. I think the interest in creating new formulations of vaccines has decreased over time. I think what people are looking forward to is thinking about whether there’s a way to make the current vaccines more efficacious or are we gonna have to reformulate them for a different type of variant in the future? I think the vaccines that we have are good, the safety profiles are fantastic and we're gonna have to think about which populations we should be targeting to get the biggest bang for our buck.”
Are you still seeing patients in the hospital with COVID?
Dr. Ken Lyn-Kew: “We're not seeing them frequently, and when you think that there are about 140 patients spread out across all the hospitals in Colorado, that's not a lot per hospital, much less per doctor in the hospital. What we are seeing is that we'll occasionally have a patient who's in an immunosuppressive state, usually drug-induced immunosuppression because we're treating something else like cancer or an autoimmune disease. They tend to come in and just not be able to clear the virus and have this up and down course of infection where they are in and out of the hospital. And we don't have the tools to just knock out the virus as easily as we'd like so these patients have a tough go of it.”
What’s it like in general in Colorado’s hospitals right now?
Dr. Anuj Mehta: “Most hospitals are at relatively low levels of COVID patients right now and we’re not seeing them in the ICU very often. The flip side of that is that hospitals are very full because we're struggling with two to three years of people either avoiding primary care or not getting their routine medical issues taken care of. But also we're seeing a lot of the other consequences of mental health issues and substance abuse problems that really blossomed in a bad way during the pandemic.”
What have you observed over the last three years in patients with long COVID?
Dr. Ken Lyn-Kew: “I think it's far more prevalent than we think. As a pulmonologist, I work both in the inpatient and outpatient setting. We have a lot of patients with chronic coughs lingering after COVID, shortness of breath, fatigue and all those patients also tend to complain about this, brain fog issue where they're not able to concentrate or focus as much.
Also, I've had people reach out to me to see what they should do about it, but the wait times are sometimes two to three months and this is a big issue that's going to stick around. I think we've only begun to understand the toll it's taking on people's ability to work, the financial repercussions, and the psychological repercussions. And the difficulty now is there's still no real common definition.”
Do you think there are people who can’t get COVID – some call them “NOVIDS”?
Dr. Diane Janowicz: “Well, there are certainly people who have not yet gotten COVID and I hesitate to say this but I'm one of those. So, the question is whether that's because I have a super boosted immune response or I had it and was asymptomatic. There is a theory out there that there is some sort of genetic mutation or deletion of a particular gene that means certain folks can’t get COVID. There are some viruses such as HIV where people have a certain gene deletion that makes them immune to acquiring HIV. Is that the same for COVID? We don't know and that's research that needs to be done and data that needs to be collected before we can make that conclusion.”
How should people be thinking about wearing masks at this stage of the virus?
Dr. Ken Lyn-Kew: “I counsel my patients that they have to weigh the risks and benefits for themselves, right? So, I tell them what their risks are and I tell them, ultimately you need to decide based on how much virus is going around, how many people are around and how much risk they have. We're not going to go back to mandatory masking everywhere. I think that that's been too politicized to happen, but I think it's important to give people the tools to make the best decisions for themselves.”
As a doctor, how are you doing after three years of a pandemic?
Dr. Anuj Mehta: “I think I've persevered fairly well through all of this. Obviously, losing so many patients and working on public health issues was trying for me. I have a great family that's been supportive, but I've seen the toll it continues to take on my colleagues. We've lost a lot of nurses at Denver Health to retirement and these were people that have been around for a long time. So that's been difficult.
I think what we've evolved to is a combination of burnout and moral injury and the moral injury stems from external factors like reports about violence on healthcare workers and legislation for a variety of things that traditionally have been conversations between healthcare workers, healthcare providers, and their patients. And now we're being told, you have to care for people this way or you can't care for people in a certain way and I think that external moral injury makes addressing burnout very difficult. I'm really worried that we're going to continue losing people from healthcare and you're going to start seeing expanding healthcare deserts in the country.”
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