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HERE'S TO YOUR HEALTH: Another season, another Covid variant

Dr. Wayne Strouse, MD

You may have noted I have been silent over the last few months. I feel the need to again take pen in hand and produce another update. This has been spurred on by two new and ongoing issues: Covid Omicron BA.5, and Monkeypox. One demands our immediate attention, while the other may or may not become an issue at some point in our future.

Dr. Wayne Strouse

Omicron BA.5 is the issue of immediate concern. Since Omicron arrived in late November, its calling card has been its high infectivity. It fairly rapidly (within 1 – 2 months) displaced the Delta variant worldwide. It was thankfully less lethal than Delta, but it caused an impressive surge of Covid infections last winter, starting in January. Not long after the Omicron BA.1.1.529 (the designation of the original Omicron variant) arrived, another Omicron subvariant came on the scene (BA.2, in March), and soon became dominant. Late April brought BA.2.12.1, and recently we've seen BA.4 and BA.5. The number after the “BA” tells you how transmissible the virus is (the higher the number, the higher the transmissibility). So BA.5 is more infective than any of the Covid strains so far. As each new strain arises, it fairly rapidly out-competes the other strains. This can happen as quickly as four to six weeks. For example, BA.5, the subvariant you probably just heard about, now causes about 70% of Covid infections (and Omicron subvariants of one type or another cause nearly 100% of Covid infections).

Omicron BA.5 is not only highly infectious, but it also is better at dodging your immune system. So, even though you may have had BA.2, you can still get BA.5. Many of you have already learned that the hard way. BA.5 seems to evade both “natural” (also known as getting sick) immunity and vaccine induced immunity.

The only “good” news is that all of the current Omicron subvariants are not causing severe disease. So, in some way, Omicron, which out competed Delta, “protected” us from the more severe disease caused by the Delta variant. Some of this is also probably because through either vaccines and/or infections, we have all become at least somewhat immune. This immunity seems to protect us from being hospitalized and dying, but not from getting infected. Realize, however, that this immunity isn't perfect, and we have seen a recent uptick in hospitalizations and deaths, though it is nowhere near what we saw with Delta.

So, bottom line: we are going to see a lot more of Covid Omicron, this time as the BA.5 subvariant. If you think you are “invincible” because you just had Covid a couple of months ago, think again.

There is one possibly hopeful note here. We haven't seen a major new variant since November, just subvariants. That's the longest time without a new variant since the pandemic began. We are not sure what that means, yet. There is another “new” subvariant of Omicron in India, currently known as Omicron BA.2.75, which may turn out to be a new variant, rather than just a subvariant. Stay tuned as we learn more about how it behaves.

So, what can you do? If you haven't been boosted since you got your original Covid vaccine series, get a booster. If you've been banking on the J&J vaccine (remember ole' “one and done”? Yeah, that's not true) -- get boosted right away. J&J is an inferior vaccine, so get boosted with the Pfizer or Moderna shot. If you are eligible for a second booster, and you haven't had a booster so far this year, you should get a second booster. And, of course, masks really do work. You should use an N-95 or KN-95 mask as they protect YOU, as well as those around you. Masks may not be mandated, but they are the smart thing to do to avoid getting Covid Omicron. I wear mine whenever I'm inside a public place where I can't keep a safe distance from others. It protects me, my family and friends, and ultimately, my patients. And, yes, it is a pain, but so is getting sick and quarantining.

If you get sick, and you have risk factors for severe disease, such as high blood pressure, diabetes, emphysema, cancer, or even being overweight (and there is a long list of other conditions found on the CDC website), talk to your doctor about receiving medication. First, get tested. If you are Covid positive, tell your doctor to see if you are eligible to receive Paxlovid—an oral treatment for Covid. You have to start taking it within five days of your first symptom, so don't delay. It can cut short your symptoms and prevent hospitalizations. My patients have really benefited from it.

There are a number of drug interactions with Paxlovid, so you may be told to temporarily stop or reduce the dose of some of your regular medicines while you are taking Paxlovid. A course of treatment is five days. It is carried by our local pharmacies, and the cost is covered--even if you don't have insurance. If the cost of a home test is an issue — talk to your doctor or Public Health (315-536-5160)--there are a number of free tests available (and insurance may reimburse you for any tests you bought, so save the receipt, and call your insurance company to find out how to get reimbursed).

Monkeypox

The second issue that has been “in the news” is: Monkeypox. This is not a major issue in Upstate New York, though there are four cases in Monroe County, and also a case or two in each of Chemung, Tompkins, and Erie (Buffalo) counties. There are about 900 cases in New York State, with 840 of the 900 cases being in New York City. No one has died during this outbreak so far. This information is up to date as of July 24, 2022, and it is changing rapidly.

Monkeypox is in the same family of viruses as Smallpox (a virus which we have eliminated worldwide). Thankfully, Monkeypox is nowhere near as deadly or disfiguring as Smallpox. Although it is rarely lethal, it can be excruciatingly painful. It is spread mostly by close, skin to skin contact, but can be picked up in the air if you are in close vicinity (for a long time) to someone who is infected. It has been found in bodily fluids, and can be spread on fabrics contaminated by someone with Monkeypox.

A handout picture made available by the UK Health Security Agency (UKHSA) on June 22, 2022, shows a collage of monkeypox rash lesions at an undisclosed date and location.

Monkeypox in the past had been limited to Africa (mainly the Democratic Republic of the Congo) until this recent outbreak. It was found outside this area usually in travelers who had recently returned from Africa, though there was an outbreak in several mid-western States in 2003 associated with exposure to infected pet prairie dogs.

This outbreak is different because we are seeing Monkeypox in Europe, the U.S., and increasingly many other countries, and we are seeing transmission from person to person. This is not however, like Covid. Transmission is mostly skin to skin. At this time, it is overwhelmingly occurring in men who have sex with men, but that could change.

The disease is associated with flu like symptoms, followed by a rash. Sometimes the flu like symptoms do not occur, or they can occur after the rash. The rash is the most distinctive symptom. It starts off as a flat red area, then develops a “bump.” The third stage is the “pox”, which is a hard bump with a little depression (called an umbilication) in the center. The pox can be extremely painful. Testing is being ramped up and is now available at the University of Rochester lab. Treatment is not usually needed, but there is a medication available for Smallpox that seems to work for Monkeypox It is in limited supply, so it is reserved for those with particularly severe disease. A vaccine is also available for those who may be at high risk for contracting Monkey pox, also in limited supply, so reserved for high risk individuals.

What monkeypox rashes can look like.

The bottom line: we will be watching this outbreak closely, but there is no immediate concern for us in Yates County at this time.

Here's To Your Health!

Dr. Wayne Strouse, MD, is a family practitioner in Penn Yan.